输尿管支架管末端圆环位置与留置支架管相关临床症状的关系

Relationship of distal end of uretcral stent position with stent-related symptoms

目的研究输尿管支架管膀胱端位置与留置输尿管支架管患者相关临床症状的关系。方法选取2014年4月至2015年4月于我院行单侧输尿管镜检并留置输尿管支架管手术患者共250例,留置1个月后拔除支架管,拔管前复查KUB了解支架管末端圆环与耻骨联合正中线的关系,复查尿常规,并完成国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life,QOL)、视觉模拟疼痛评分(visual analogue scale,VAS)、血尿症状评分。结果复查KUB时支架管末端圆环位于耻骨联合正中线患侧的69例(A组),末端圆环位于耻骨联合正中线的117例(B组),末端圆环位于耻骨联合正中线对侧的64例(C组)。3组患者IPSS评分比较均存在统计学差异(P<0.01),B组最高,为(14.8±5.7);3组患者QOL评分、VAS腰痛评分、VAS尿痛评分比较差异均有统计学意义(P<0.01),其中对B组患者生活质量影响最大,评分为(3.7±1.4),VAS腰痛评分A组最高,为(5.3±2.1),VAS尿痛评分B组最高,为(4.5±3.1);血尿症状评分B、C组比较差异无统计学意义(P=0.32),A组与B组、C组比较差异有统计学意义(P<0.01);3组患者尿常规白细胞对比差异无统计学意义(P=0.10,P=0.63,P=0.33)。结论输尿管支架管末端圆环位置与留置支架管相关临床症状密切相关,良好的末端位置能显著改善患者相关临床症状并提高生活质量。

Objective To observe the relationship of the distal end of ureteral stent position and patients＇ stent-related symptoms. Methods A total of 250 patients who underwent unilateral ureterscopy and indweh ureteral stents in our hospital from April 2014 to April 2015 were involved in this study. Kidney, ureter and bladder plains （KUB） were taken to identify the positions of ureteral stent distal end before removing the stents after indwelling for 1 month. Urine was also analyzed, and the patients finished the following questionnaires before removing the stents： international prostate symptom score （IPSS）, quality of life （QOL）, visual analogue scale （VAS） and hematuresis score. Results There were 69 patients in group A, and the end rings of ureteral stents were ipsilateral. There were 117 patients in group B, and the end rings were crossed with the perpendicular line. There were 64 patients in group C, and the end rings were completely contralateral. The IPSS of the 3 groups had statistically significant difference （ P 〈 0. 01 ）, and group B was the highest, with 14. 8 _＋ 5.7. The QOL scores of the 3 groups had statistically significant difference （P 〈 0.01 ）, and the score of group B was the highest, showing more impact on the QOL. The lumbago VAS of the 3 groups had statistically significant difference （P 〈 0. 05 ）, and group A got the highest score. The odynuria VAS of the 3 groups had statistically significant difference （ P 〈 0.05 ）, and group B got the highest score. Hematuresis was severe in group B, and there were statistically significant differences between group A and group B and between group A and group C （ P 〈 0. 01 ）, but there was no statistical significant difference between group B and group C （P = 0. 32）. Leukocytes in urine were increased, but no statistical significant differences were found in the 3 groups （P = 0. 10, 0.63, and 0.33）. Conclusion Ureteral stent end ring positions are relevant to the patients＇ stent-related symptoms while indwelling the ureteral stents, so proper positions of the stent ends can significantly improve stent-related symptoms and QOL.