老年男性经尿道输尿管镜钬激光碎石术中留置带线双J管的临床疗效

Clinical Effect of Double J Tube Indwelled to Elderly Male Patients Given Transurethral Holmium Laser Lithotripsy

目的观察老年男性经尿道输尿管镜钬激光碎石术中留置带线双J管的并发症和对患者生活质量的影响。方法回顾性分析2012年1月至2014年1月,采用经尿道输尿管镜钬激光碎石术治疗输尿管结石男性患者120例的临床资料,将患者按入院时间分为两大组,分别为对照组患者40例,入院时间为2012年1月至2013年1月,术中常规留置未带线双J管;留置组患者80例,入院时间为2013年1月至2014年1月,术中留置带线双J管。留置组80例患者根据留置带线双J管的时间又分为两小组,分别为A组,患者40例,留置时间2周;B组,患者40例,留置时间4周。分别于术前、术后3个月行^(99)Tc^m-DTPA核素肾图检查,并记录患肾的肾小球滤过率;留置内支架管期间观察并记录并发症的发生情况,术后随访3个月,评价患者术后的疼痛模拟评分(visual analogue scale,VAS)、生活质量指数评分(quality of life,QOL)情况,并记录患者恢复正常排尿所需时间。结果术后,三组患者的肾小球滤过率(glomerular filtration rate,GFR)均得到明显升高,且A组、B组的GFR明显高于对照组(P<0.05),但A组与B组无显著差异(P>0.05)。双J管留置带管期间,A组QOL评分与对照组比较,差异有显著意义(P<0.05),但B组患者的QOL评分与对照组比较,差异无显著意义(P>0.05);A组、B组患者的VAS评分及拔管后恢复正常排尿所需时间均明显低于对照组,差异具有显著意义(P<0.05);且A组、B组患者的VAS评分、QOL评分及恢复正常排尿时间比较,差异有显著意义(P<0.05)。结论老年男性输尿管结石患者行输尿管软镜联合钬激光碎石术中留置带线双J管具有很好的可行性及安全性,在不增加并发症和影响患者生活质量的前提下,还能更好的促进结石清除、恢复肾功能、减轻疼痛,且缩短双J管留置时间为2周时,其安全性更高、预后更好。

Objective To explore the influence of indwelling double J tube with wire on the complications and quality of life of elderly male pa- tients given transurethral holmium laser lithotripsy.Methods A retrospective analysis was made on 120 male patients having received transurethral holmium laser lithotripsy in our hospi- tal from Jan. 2012 to Jan. 2014. They were divided into groups by the time of admission. While the patients （40） admitted to the hos- pital and given transurethral holmium laser lithotripsy without being indwelled double J tubes with wire from Jan. 2012 to Jan. 2013 forming the control group, the 80 patients admitted from Jan. 2013 to Jan. 2014 were further split into two groups： Group A with 40 patients indwelled double J tubes with wire for 2 weeks and Group B with 40 patients indwelled double J tubes with wire for 4 weeks. 99Tcm-DTPA radionuclide renography examination was performed and the kidney glomerular filtration rates of the patients recorded re- spectively before the surgery and 3 months after the surgery. The occurrence of complications during the indwelling period was observed and recorded. A 3 months＇follow-up was conducted to evaluate the postoperative pain analogue scale, quality of life （QOL） score and record the time required for the patients to restore normal urination,Results After the operation, the glomerular filtration rates （GFR） of the patients in all the three groups rose remarkably. While the GFRs of Group A and Group B being much higher （ P 〈 0.05 ） than that of the control group, the difference between Group A and Group B was not significant （P 〉 O. 05）. For the indwelling period, the difference between Group A and the control group in QOL score was statistically significant （P 〈 O. 05）, but the difference between Group B and the control group was not great （ P 〉 O. 05 ）. Compared with the control group, both Group A and Group B had a lower VAS score and shorter time required for restoring normal uri- nation, and the differences were statistically significant （P 〈 0. 05）. Conclusions Indwelling elderly male patients of ureteral calculi with double J tube with wire during the holmium laser lithotripsy is feasible and safe. Without increasing complications and affecting life quality, it may promote stone clearance and recovery of renal function, reduce inter pain, shorten the indwelling time （two weeks） of double J tubes.