输尿管镜碎石术后早期拔除带线双J管的前瞻随机对照研究

Early Extraction of Ureteral Stent with String after Urethroscopic Lithotripsy: A Prospective Randomized Control Trial

目的探讨输尿管镜碎石术后早期拔除带线双J管的安全性及可行性。方法选择2013年8月～2014年11月在我科住院行输尿管镜碎石术并留置双J管的连续病例为研究对象,共124例,随机分为两组：A组65例,输尿管术后第5 d拔除带线双J管;B组59例,输尿管术后第4周拔除双J管。观察比较拔管前后腰痛、肉眼血尿、泌尿系感染、下尿路刺激征、输尿管狭窄等不良反应发生率、拔管时疼痛评分以及费用等差异。结果所有患者术后均顺利拔除双J管,且拔管后结石排除率100%,均未见输尿管狭窄、石街形成发生。B组患者腰痛、肉眼血尿、泌尿系感染及下尿路刺激征的发生率均随留置时间延长而明显增加,拔除双J管后不良反应显著降低。拔管后1周A、B两组各不良反应发生率比较,差异具有统计学意义（P〈0.05）。A组拔管时VAS评分及费用显著低于B组,差异有统计学意义（P〈0.05）。结论输尿管镜碎石后早期拔除体内双J管是安全有效的,双J管尾端捆绑丝线不增加并发症风险,并能减轻患者拔管痛苦,值得推广。

Objective To explore the safety and efficacy of early extraction of ureteral stent after urethroscopic lithotripsy. Methods A total of 124 consecutive cases underwent uncomplicated urethroscopic lithotripsy and ureteral stent insertion in our hospital were involved in the prospective research between August 2013 and November 2014. The 124 patients were randomized into two groups： The group A（ n = 65） was performed extraction of ureteral stent with string early on the fifth day after urethroscopic lithotripsy and the group B（ n = 59 cases） were carried out extraction of ureteral stent on the forth week after urethroscopic lithotripsy. The adverse event incidences such as loin pain,gross hematuria,urinary infection,lower urinary irritation symptoms,the VAS and medical cost of the extubation were compared between the two groups. Results All patients were succeed in the extubation of double J stent with 100 % of stones clearance rate. No complication as ureterostenoma or ureteral stones street was found. The incidence of loin pain,gross hematuria,urinary infection,and lower urinary irritation symptoms were significantly increased with the prolongation of the stent retained time,and significantly decreased after removal of the double J stent. There was statistical difference in complication rate in one week after drawing stent between A and B group（ P〈0. 05）. Both the VAS score and the cost of extubation in group A were significantly lower than those in group B,and there was statistic difference between two groups（ P〈0. 05）. Conclusion It is safe and effective that early removal of double J after urethroscopic lithotripsy,double J stent tube end with strings will not increase the risk of postoperative complications,even can relieve the pain of extubation,and it is worthy of promotion.