双J管在输尿管镜钬激光碎石术中的应用

Application of double J tube in holmium laser lithotripsy

目的探讨双J管在输尿管镜下钬激光碎石术中应用的适应证及并发症的防治。方法对57例行输尿管镜下钬激光碎石术后留置双J管的患者的临床资料进行系统分析并结合文献复习。结果 57例患者中肉芽包裹性结石6例,碎石并切除肉芽后留置双J管;结石下方存在不同程度的输尿管扭曲狭窄,碎石后在扩张狭窄处后留置双J管44例;钬激光碎石时部分较大结石上移至肾盂7例,留置双J管后行体外冲击波碎石术治疗;复查腹部X线平片示结石均完全排出。留置双J管后出现膀胱刺激症状21例(36.8%),肉眼血尿11例(19.3%),腰部隐痛不适症状13例(22.8%),予对症治疗后症状均缓解。结论输尿管镜下钬激光碎石术后根据需要可留置双J管,双J管具有内支架及内引流的作用,置入和取出简单,安全可靠,并发症较轻,效果显著。

Objective To investigate the indication and prevention of complications for theclinical application of double-J tube in transureteroscopic holmium laser lithotripsy. Methods Analyzed the clinical data of 57 patients who indwelled the double-J tube after transureteroscopic holmium laser lithotripsy,and reviewed the literatures. Results In 57 patients,there are 6 cases of granulation wrapped stone,double-J tube was indwelled after gravel and removal of granulation.There are 44 patients exist ureteral narrow below the stone,and double-J tube was indwelled after gravel and the expansion of the narrow place. The stone removed into pelvis occurred in 7 patients during transureteroscopic holmium laser lithotripsy,double-J tube was indwelled and then extracorporeal shock wave lithotripsy was used to treat the moved stone. Reviewed KUB shown that the stones were fully discharged. There were 21 patients（ 36. 8%） suffered bladder irritation,11 patients（ 19. 3%）had gross hematuria,13 patients（ 22. 8%） suffered lumbar pain symptoms after the indwelling of double-J tube,these symptoms were relieved by symptomatic treatment. Conclusion Double-J tube can be used after transureteroscopic holmium laser lithotripsy; it has stent and internal drainage function. The insertion and removal of Double-J tube is simple,safe and reliable. Moreover,the complication is lighter and the effect is significant.