上尿路结石腔内治疗术后留置双J管致严重血尿分析

Analysis of double J ureteral stent caused severe hematuria after endourological management of upper urinary stones

目的探讨上尿路结石腔内治疗术后留置双J管导致严重血尿的原因及防治措施。方法回顾分析11例上尿路结石腔内治疗后留置双J管导致严重血尿病例的资料。结果11例于出院1周后出现不同程度肉眼鲜红血尿及膀胱刺激症状,活动后加重,2周后11例血尿无好转,血常规血红蛋白(Hb)均较出院时下降≥20g/L,1例需输血治疗,5例出现腰痛及发热,KUB示4例出现输尿管石街形成,4周时中段尿培养8例,阳性3例。11例拔管时8例出现双J管表面钙盐沉积。结论双J管在上尿路结石腔内治疗术后作为支架及引流方面有重要作用,但亦可导致严重血尿的并发症。正确掌握腔内手术操作技巧、术后避免过度活动、多饮水、口服抗生素及抑石药物防止感染、缩短留管时间等,可有效地防止严重血尿的产生。

[Objective] To evaluate why the patient who was placed double J ureteral stent after endourological management of upper urinary stones occurred severe hematuria. [Methods] The clinical data of 11 patients with severe hematuria resulted from double J ureteral stent after endourological management of upper urinary stones were reviewed. [Results] Severe hematuria occurred in all cases 1 week after discharge and worsen during activity. 5 cases complicated with loin pain and fever. Transfusion needed in 1 case. X-ray film showed steinstress in 4 cases. Urine culture was performed in 8 cases and postive in 3 cases. Calcium salts deposition was found in 8 cases when removing the stent. [Conclusions] Double J ureteral stent is very helpful in drainage and preventing ureter stricture after endourological management of upper urinary stonesl but it may comlicated severe hematuria. The keys for prevention of this complication are： gentle endoscopic performance, avoiding overactive postoperatively, drinking water, oral antibiotics or stone-inhibitor drug, and short-time ureteric stenting.