术前不同处理方式对输尿管软镜碎石术治疗效果的影响  

Different preoperative treatment methods on the therapeutic effect of flexible ureteroscopic lithotripsy

作　　者：熊冰 钟旭峰 王顺峰 秦龙 徐呈云 XIONG Bing;ZHONG Xufeng;WANG Shunfeng;QIN Long;XU Chengyun(Department of Urology,Dongyang People’s Hospital,Zhejiang Province,Dongyang,Zhejiang 322100,China)

机构地区：[1]浙江省东阳市人民医院泌尿外科,浙江东阳322100

出　　处：《医药前沿》2022年第33期4-7,共4页Journal of Frontiers of Medicine

摘　　要：目的:探讨术前口服坦索罗辛与术前留置D-J管对输尿管软镜碎石术治疗效果的影响。方法:回顾性分析2021年2月—2022年2月于浙江省东阳市人民医院行输尿管软镜碎石术治疗的326例上尿路结石患者的临床资料,根据术前处理方法不同分为药物组(n=172)与支架组(n=154)。药物组患者术前1周口服坦索罗辛,未预留D-J管,在完善检查排除手术禁忌证后一期行输尿管软镜碎石术治疗。支架组在术前1~2周经输尿管镜先置入D-J管,在确认D-J管位置良好后予以预防性口服抗生素,择期行输尿管软镜碎石术。比较术前不同处理方式对输尿管软镜碎石术治疗效果。结果:药物组的手术时间为(61.55±13.47)min,支架组的手术时间为(59.47±12.58)min,两组比较,差异无统计学意义(t=1.375,P=0.372)。药物组术中置鞘成功率为91.86%(158/172),支架组术中置鞘成功率为97.40%(150/154),两组比较,差异无统计学意义(χ^(2)=3.477,P=0.055)。药物组有8例(4.65%)残留结石>4 mm,支架组有5例(3.25%)残留结石>4 m m,两组比较,差异无统计学意义(χ^(2)=0.419,P=1.000)。两组患者术中均未出现输尿管撕脱、穿孔,未发生输尿管软镜鞘损伤肾实质。结论:术前口服坦索罗辛与术前留置D-J管应用于输尿管软镜碎石术的效果差异无统计学意义,两组效果相当,临床应根据患者的实际需求进行选择。Objective To investigate the effect of preoperative oral Tamsulosin and preoperative indwelling D-J tube on the therapeutic effect of flexible ureteroscopic lithotripsy.Methods A retrospective analysis was performed on the clinical data of 326 patients with upper urinary tract stones treated with flexible ureteroscopic lithotripsy in Dongyang People’s Hospital of Zhejiang Province from February 2021 to February 2022.326 patients were divided into the drug group and the stent group,according to the different preoperative intervention.Patients in the drug group(172 patients)were treated with flexible ureteroscopic lithotripsy for oral tamsulosin 1 week before surgery,without reserved D-J tubes,and after complete examination to exclude contraindications to surgery.In the stent group(154 cases),the D-J tube was first inserted by ureteroscopy 1~2 weeks before surgery,and prophylactic oral antibiotics were given after confirming that the D-J tube position was good,and flexible ureteroscopic lithotripsy was electively undertaken.The effects of different preoperative treatments of flexible ureteroscopic lithotripsy were compared.Results The operation time of the drug group was(61.55±13.47)min and the operation time of the stent group was(59.47±12.58)min,and there was no significant difference between the two groups(t=1.375,P=0.372).The success rate of intraoperative sheath placement in the drug group was 91.86%(158/172)and that in the stent group was 97.40%(150/154),and there was no significant difference between the two groups(χ^(2)=3.477,P=0.055).There were 8 patients(4.65%)residual stones>4 mm in the drug group and 5 patients(3.25%)residual stones>4 mm in the stent group,and there was no significant difference between the two groups(χ^(2)=0.419,P=1.000).In both groups,there was no ureteral avulsion or perforation during surgery,and no flexible ureteroscopic sheath injury to the renal parenchyma.Conclusion Although the effect of preoperative oral tamsulosin and preoperative indwelling D-J tube in flexible uretero

关 键 词：输尿管软镜碎石术 坦索罗辛 D-J管 输尿管软镜鞘 

分 类 号：R693[医药卫生—泌尿科学]