保留斑马导丝在输尿管镜手术中对减少并发症的作用  

Effect of reserving zebra guide wire during ureteroscopy on reducing surgical complications

作　　者：段启新 DUAN Qi-xin(Department of Urology,Nanyang Central Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市中心医院泌尿外科,河南南阳473000

出　　处：《医药论坛杂志》2023年第23期23-26,共4页Journal of Medical Forum

基　　金：河南省医学科技攻关计划普通项目(2020120346)。

摘　　要：目的探讨输尿管镜手术中保留斑马导丝对减少手术并发症的作用。方法选取2019年8月—2020年8月南阳市中心医院行输尿管镜手术的患者90例,根据手术中不同的操作方法分组(观察组和对照组各45例)。两组患者均进行输尿管镜手术,观察组患者在输尿管镜抵达结石处后,引导斑马导丝穿过石体,退镜时仍将其置于输尿管中,遂先后再次实施进境、碎石、取石等操作,并保留双J管;对照组患者则是在输尿管镜到达结石部位之后退出斑马导丝,然后直接使用钬激光进行碎石和取石处理,在手术后留置双J管。在完成手术之后的3天至5天使用腹部X线平片和B超对患者进行复查,观察两组患者的治疗效果。结果观察组治疗有效率(91.1%)高于对照组(80.0%),差异具有统计学意义(P<0.05);观察组术后并发症发生率(8.9%)显著低于对照组(20.0%)(P<0.05);观察组中上段有5例移入肾盂,上移的概率为11.1%;中下段有3例移入肾盂,上移的概率为6.7%,总体的上移概率为17.8%;对照组中上段有8例移入肾盂,上移的概率为17.8%,中下段有5例移入肾盂,上移的概率为11.1%,总体的上移概率为28.9%,差异具有统计学意义(P<0.05);观察组中出现输尿管腔道丢失的例数为2例,发生率为4.4%;对照组中出现输尿管腔道丢失的例数为6例,发生率为13.3%,差异具有统计学意义(P<0.05)。结论保留斑马导丝显著提升输尿管镜手术安全性,降低不良事件发生率,有效推动手术进程。Objective To explore the effect of preserving zebra guide wire in ureteroscopic surgery on reducing surgical complications.Methods A total of 90 patients who underwent ureteroscopy in Nanyang Central Hospital from August 2019 to August 2020 were selected and divided into groups according to different operation methods(45 cases in the ob-servation group and 45 cases in the control group).Ureteroscopy was performed in both groups.The observation group guided the zebra wire through the stone after the ureteroscopy arrived at the stone,and the zebra wire was still placed in the ureter when the ureteroscopy was removed.Then,the operation of entry,lithotriptic and stone extraction was per-formed again,and the double J tube was retained.The control group drew the zebra wire after the ureteroscope reached the stone site,and then directly used the holmium laser for lithotripsy and stone extraction.The double J tube was ind-welled after surgery.The patients were reexamined 3 to 5 days after the operation with plain abdominal X-ray and B-ultrasound,and the therapeutic effect of the two groups was observed.Results The effective rate of observation group(91.1%)was higher than that of control group(80.0%),and the difference was significant(P<0.05).The inci-dence of postoperative complications in observation group(8.9%)was significantly lower than that of control group(20.0%)(P<0.05).In the observation group,5 cases were transplanted into the renal pelvis in the middle and up-per segment,and the probability of upward migration was 11.1%.In the middle and lower segment,3 cases were trans-planted into the renal pelvis,the probability of upward movement was 6.7%,and the overall probability of upward movement was 17.8%.In the control group,8 patients in the middle and upper segments were transplanted into the renal pelvis,the probability of upward movement was 17.8%,and 5 patients in the middle and lower segments were trans-planted into the renal pelvis,the probability of upward movement was 11.1%,the overall probability of upward

关 键 词：输尿管镜手术 斑马导丝 并发症 

分 类 号：R699.4[医药卫生—泌尿科学]