术前预置双J管对输尿管软镜碎石取石术治疗肾结石疗效的影响  

Effect of preoperative double J stents on the efficacy of flexible ureteroscopic lithotripsy in the treatment of kidney stones

作　　者：疏杰 樊松[1] 赵磊[1] 王建忠[1] 宋正尧[1] 刘明[1] 侯冰冰[1,2,3] 许悦贤 郝宗耀 Shu Jie;Fan Song;Zhao Lei;Wang Jianzhong;Song Zhengyao;Liu Ming;Hou Bingbing;Xu Yuexian;Hao Zongyao(Department of Urology,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China;Institute of Urology,Anhui Medical University,Hefei,Anhui 230022,China;Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科,安徽合肥230022 [2]安徽医科大学泌尿外科研究所,安徽合肥230022 [3]泌尿男科疾病研究与医学转化安徽省重点实验室,安徽合肥230022

出　　处：《泌尿外科杂志（电子版）》2024年第1期1-5,共5页Journal of Urology for Clinicians(Electronic Version)

基　　金：国家自然科学基金面上项目(82070724,82370768);安徽省高校自然科学研究项目(2023AH040372);安徽省临床医学研究转化项目(202204295107020031)。

摘　　要：目的探讨输尿管软镜碎石取石术(flexible ureteroscopic lithotripsy,fURL)术前预置双J管对肾结石患者疗效的影响。方法回顾性分析2021年9月至2022年3月安徽医科大学第一附属医院收治的180例行fURL肾结石患者的临床资料。对照组(n=100)术前未预置输尿管支架,研究组(n=80)术前2周预置双J管。比较两组围手术期临床指标、视觉模拟评分法(visual analogue scale,VAS)、威斯康辛生活质量问卷(the Wisconsin Stone Quality of Life questionnaire,WISQOL)评分。结果对照组术后出现输尿管黏膜损伤3例,持续高热2例,研究组无并发症发生,对照组并发症发生率高于研究组,差异有统计学意义(P<0.05);对照组术前尿白细胞计数、初始尿培养阳性率、术前膀胱过度活动症(overactive bladder,OAB)发生率、一次输尿管通道鞘(ureteral access sheath,UAS)置入率均低于研究组,差异有统计学意义(P<0.05)。术后,对照组VAS评分低于研究组,WISQOL评分高于研究组,差异均有统计学意义(P<0.05);两组精力、睡眠、工作和家庭、对于出行和亲密行为的关注评分差值比较,差异无统计学意义(P>0.05);对照组营养和药物治疗、症状、总体情绪评分差值均高于研究组,差异有统计学意义(P<0.05)。结论术前预置双J管能够提高fURL中一次UAS置入成功率,但会降低患者生活质量,增加OAB和尿路感染发生率,且需承担额外的术前置双J管手术风险和费用。Objective To explore the effect of preoperative double J stent placement on the efficacy of flexible ureteroscopic lithotripsy(fURL)in patients with kidney stones.Methods Retrospective analysis of clinical data of 180 patients with kidney stones admitted to the First Affiliated Hospital of Anhui Medical University from September 2021 to March 2022,all of whom underwent ureteroscopic holmium laser lithotripsy.The control group(n=100)did not have a pre-installed ureteral stent before surgery,while the study group(n=80)had a pre-installed double J stents 2 weeks before surgery.Perioperative clinical indicators,visual analogue scale(VAS),and the Wisconsin Stone Quality of Life questionnaire(WISQOL)scores between two groups were compared.Results There were 3 cases of ureteral mucosal injury and 2 cases of persistent high fever in the control group after surgeries,while no complications occurred in the study group,and there was a significant difference in the incidence of complications between the two groups(P<0.05).The preoperative urine white blood cell count,initial positive urine culture rate,incidence of overactive bladder(OAB),and primary ureteral access sheath(UAS)insertion rate in the control group were all lower than those in the study group,and the differences were statistically significant(P<0.05).After surgeries,the VAS score of the control group was lower than that of the study group,and the WISQOL score was higher than that of the study group(P<0.05).The differences in scores of energy,sleep,work and family,attention to travel and intimate behavior between the two groups were not statistically significant(P>0.05).The differences in nutritional and medication treatment,symptoms,and overall emotional scores between the control group and the study group were statistically significant(P<0.05).Conclusion Preoperative double J stent placement can improve the success rate of UAS insertion in fURL,but it will reduce the patient's quality of life,increase the incidence of OAB and urinary tract infections,and requi

关 键 词：肾结石 输尿管软镜碎石取石术 输尿管支架管 生活质量 

分 类 号：R692.4[医药卫生—泌尿科学]