输尿管镜取石手术后不留置支架管的探讨

A Evaluation of Selectei Patients who Underwent Stentless Ureteroscopy

目的探讨输尿管镜取石术后不留置支架管的可行性,气压弹道碎石或钬激光碎石及输尿管镜取石,可根据指征术后留置支架管。结果不留置支架管指征包括大部分患者恢复顺利,平均住院4.2天,X线平片或B超随访结石消失;并发症主要表现为轻度肉眼血尿21例,占26.9%;一过性下尿路症状16例,占20.5%;与上尿路梗阻有关的腰痛13例,占16.7%,其中5例腰部症状明显给予重新置入支架管,占6.4%;与泌尿系统感染相关的发热9例,占11.5%。上述并发症常发生在术后短期,多可自行消失,部分患者服用奥昔布宁、坦素罗辛后缓解。结论输尿管镜术后不留置支架管是可行和安全的,有助于减少留置支架管所导致的并发症及降低患者治疗费用。

OBJECTIVE To evaluate the selected patients who underwent stentless ureteroscopy. METHODS Of 356 ureteroscopy for urolithiasis with lithotripsy or holmium laser performed at our hospital from Feb, 2005 to Aug, 2008, a ureteral stent was not placed in 78（21.9%） cases. M/F： 46/32, mean age 42.7 years. The site of calculi in upper or lower segment of ureter was 17 or 61 cases respectively. The eriterias of stentless ureteroscopy included （1）short history with mild obstruction, （2）stone size ≤1cm, （3）age〈60 years, （4） no significant residual stone, （5） mild ureteral edema, （6） unilateral procedure, （7） normal renal function, （8）without hypertension, diabetes or other severe diseases. Urethral catheter or ureteral catheter in some cases was placed and withdraw 1 or 2 days later.The patients were followed up for 4 weeks. RESULTS Majority of cases bad recovered smoothly.Mean hospitalization 4.2 days. Plain X-ray or ultrasound follow-up had shown no residual stone.Main complications had been observed including mild gross hematuria in 21 cases（26.9%）, transient LUTS in 16 cases（20.5%）, frank pain related to urinary obstruction in 13 cases（16.7%）, among those 5 （6.4%） cases had needed to install a ureteral stent and fever related to urinary infection in 9 cases （11.5%）. Majority of complications had happened in the short period postoperatively with a natural relief, some had recovered with medicine of oxybutynin and tamsulosin. CONCLUSIONS Stentless ureteroseopy could be safe, effective and suitable for selected patients, which could help reduce the complications and cost related to ureteral stent.