非膀胱镜非麻醉下小儿输尿管双J管取出术与膀胱镜下取管的对比研究

A Comparative Study Between Cystoscopic Removal of Pediatric Ureteral Double-J Tube Without Anesthesia and Traditional Method

目的探讨非膀胱镜非麻醉下小儿输尿管双J管取出术的可行性。方法 2014年1月～2015年5月留置输尿管双J管患儿50例,年龄10个月～8岁,按随机数字表法随机分成改良组和传统组各25例。改良组水合氯醛灌肠镇静,用丝线圈经导尿管取出双J管;传统组静脉吸入复合麻醉,F6或F8膀胱镜下取出双J管。比较2组成功率、手术时间、住院时间、术后排尿不适以及镜下血尿等指标。结果改良组成功取出23例,失败2例,传统组25例均成功取出,二者成功率差异无统计学意义（Fisher检验,P=0.490）。改良组和传统组手术时间分别为（14.3±3.6）和（40.2±4.1）min（t=-23.630,P=0.000）,住院时间分别为（1.2±0.4）和（2.7±0.6）d（t=-11.320,P=0.000）,术后排尿不适分别为1例（4%）和8例（32%）（χ2=4.334,P=0.037）,镜下血尿分别为1例（4%）和9例（36%）（χ2=5.484,P=0.019）,差异均具有统计学意义。结论非膀胱镜非麻醉下小儿输尿管双J管取出术安全、可行、有效,值得临床推广。

Objective To investigate the feasibility of cystoscopic removal of pediatric ureteral double-J tube by means of operation without anesthesia. Methods We chose 50 children with ureteral double-J tube,aged between 10 months and 8 years old,from January 2014 to May 2015. The patients were randomly divided into two groups（ 25 cases in each group）. The experimental group were given chloral hydrate composure by enema and the double-J tube was taken out by the urinary catheter with the surgical silk suture. In the control group,the double-J tube was taken out under cystoscope（ F6 or F8） in anesthesia. The success rate,operation time,hospital stay,postoperative urination discomfort and microscopic haematuria were compared between the two groups. Results The removal surgery was successfully accomplished in 23 cases in the experimental group,with 2 cases of failure. The removal was successfully completed in all the 25 cases in the control group. The success rates between the two groups were not significantly different（ P = 0. 490）. There were statistically significant differences between the experimental group and the control group in operation time[（ 14. 3 ± 3. 6） min vs.（ 40. 2 ± 4. 1） min,t =- 23. 630,P = 0. 000],hospital stay [（ 1. 2 ± 0. 4） d vs.（ 2. 7 ± 0. 6） d,t =- 11. 320,P = 0. 000 ],postoperative urination discomfort [1 case（ 4%） vs. 8 cases（ 32%）,χ2= 4. 334,P = 0. 037] and microscopic haematuria [1 case（ 4%） vs. 9 cases（ 36%）,χ2= 5. 484,P = 0. 019]. Conclusion Cystoscic removal surgery of pediatric ureteral double-J tube without anesthesia is safe,feasible,and effective,being worthy of clinical promotion.