双J管并发症的预防和治疗

目的探讨上尿路手术后留置双J管后产生并发症的原因、预防和处理方法。方法通过对已产生了双J管并发症的35患者的临床资料分析,讨论如何有效防治双J管并发症。结果附壁结石的形成和长大导致取管困难3例,通过ESWL和输尿管镜取出;输尿管脱套伤无;基本上每根J管都不同程度继发附壁或管内结石;反复尿路感染2例;均有不同程度的反复血尿、膀胱刺激征;慢性炎性狭窄1例;未发现继发输尿管肿瘤;双J管残留输尿管内15例,输尿管镜取管成功13例,开放手术取出2例;超过1年时间才取J管的6例,为此产生医疗纠纷1例。结论可靠置入J管,书面详情告知和随访登记,避免漏取或延迟取管导致安全隐患,确定统一留置时间标准显得非常必要。

Objective To explore the causes,precautions and treatment of complications after retention of double J stent in upper urinary tract operations.Methods 35 cases suffering from complications after retention of double J stent were included in our study.The clinical data were analyzed and we discussed how to prevent and treat complications after retention of double J stent effectively.Results 3 cases experienced formation and growing up of attached calculi which lead to difficulty in extracting of double J stent.The stents were extracted by ESWL and ureteroscope. No degloving injury was observed.And attached or inner calculi were found in each stent.2 cases experienced urinary infection repeatedly and accompanied by hematuria and cystic stimulation.1 case of chronic inflammation stricture,0 case of secondary ureter carcinoma were observed.15 cases suffered form retained double J stent,of which 13 were solved by ureteroscope and 2,open surgery.Stents of 6 cases were extracted after over 1 year,which leading to 1 medical malpractice.Conclusion It is vital of positioning double J stent reliably,informing minutely in written,registering of follow-up and definition of unique standard of period of retention to avoid potential safety hazard arising from delayed and forgotten extraction of double J stent.