输尿管中上段结石碎石术后双J管留置效果临床观察

Clinical observation on the effect of indwelling of double J catheter after lithotripsy for upper and middle ureteral calculi

目的探讨输尿管中上段结石碎石术后双J管的留置效果。方法选取2017年9月至2018年11月宁波市鄞州区第二医院接诊的65例输尿管上段结石患者作为研究对象。按照双J管处置时间将患者分成研究组与对照组,其中研究组45例患者双J管留置时间2周;对照组20例患者,双J管留置时间4周,两组拔出方法均为经尿道膀胱镜下拔管。比较两组患者术后出现腰腹疼痛、下尿路刺激征、双J管位移、肉眼血尿以及管壁钙盐沉积等并发症的发生率。比较两组患者手术前后24 h尿离子检测项目水平的变化情况。结果研究组患者的术后腰腹疼痛(22.22%)、下尿路刺激征(71.11%)、双J管位移(0%)、肉眼血尿(71.11%)以及管壁钙盐沉积(6.67%)的发生率明显低于对照组患者腰腹疼痛(50.00%)、下尿路刺激征(95.00%)、双J管位移(25.00%)、肉眼血尿(95.00%)以及管壁钙盐沉积(25.00%),两组比较差异有统计学意义(P均<0.05)。两组患者在双J管拔出后1周以及3个月的尿常规复查结果均在正常水平,1个月后的腹部X线平片(kidney ureter bladder,KUB)检查结果显示,两组患者均无明显泌尿系统结石的残留。研究组与对照组的手术前后24 h尿离子检测水平的变化情况相比,差异无统计学意义(P>0.05)。2周后拔管的患者与4周后拔管的患者相比也未出现明显的不适。结论输尿管中上段结石碎石术后双J管留置能够有效减少并发症的发生且不会对残石的清除与肾功能的恢复产生影响。且在置管后2周对双J管进行拔除为最佳时间。

Objective To observe the effect of indwelling of double J catheter after lithotripsy of upper and middle ureteral calculi.Methods From September 2017 to November 2018,65 patients underwent lithotripsy for upper ureteral calculi in our hospital were enrolled in the study and were divided into observation group(45 cases)and control group(20 cases).Patients in the observation group had double J catheter for 2 weeks,while those in the control group had double J tube for 4 weeks.Tubes were removed from patients in both groups by transurethral cystoscopy.The incidence of complications such as back and abdominal pain,lower urinary tract irritation symptoms,double J tube dislocation,hematuria and calcium deposited in the wall of the tube were compared between the two groups.The changes of 24 hours urine ion test parameters before and after operation were also compared.Results The occurrence rates of back and abdominal pain,lower urinary tract irritation symptom,double J tube dislocation,hematuria and wall calcium deposition in the observation group were significantly lower than those in the control group(22.22%vs 50.00%;71.11%vs 95.00%;0%vs 25.00%;71.11%vs 95.00%;6.67%vs 25.00%;P<0.05).The results of routine urinary test in the two groups were normal one week and three months after double J tube removal.The abdominal KUB examination ray showed no residual urinary calculi in the two groups one month after the removal.There was no significant difference in 24 h urine ion test between the two groups before and after operation(P>0.05).No significant clinical discomfort was observed in patients of both groups.Conclusions Double J-tube indwelling after lithotripsy of upper and middle ureteral calculi can effectively reduce the occurrence of complications without affecting the removal of residual stones and the recovery of renal function.Double J tube can be removed two weeks after surgery.