输尿管软镜碎石术前留置双J管的随机对照研究

A randomized controlled clinical study on preoperative double J tube placement in flexible ureteroscopic lithotripsy

目的分析术前留置双J管对经尿道输尿管软镜碎石术疗效及安全性的影响。方法对2014年11月至2015年3月广州医科大学附属第五医院60例接受经尿道输尿管软镜碎石取石术的结石患者进行随机分组对照试验。每组30例,一组做好术前准备后直接行经尿道输尿管软镜碎石取石术（A组）,另一组于入院当日局麻下予留置输尿管双J管1周后再进行手术（B组）,全部病例术中均应用软镜通道鞘。对两组患者手术相关数据进行统计分析。结果本研究60例患者均成功进行经尿道输尿管软镜碎石取石术。A组有6例置入输尿管软镜通道鞘前需要主动扩张输尿管,B组则全部一次性成功放置软镜通道鞘。A、B两组一次性放置软镜通道鞘成功率分别为24/30（80%）、30/30（100%）,差异比较有统计学意义（P〈0.05）。A、B两组术后1~2 d结石清除率分别为60.0%、56.7%,术后1个月结石清除率为96.7%、93.3%,住院治疗费用差异无统计学意义。两组住院时间分别为（6.7±1.7）d、（11.7±3.7）d,差异比较有统计学意义（P〈0.05）。A组中有1例患者术后1个月出现输尿管石街,再次入院行输尿管镜取石术。两组患者均未出现严重并发症。结论经尿道输尿管软镜碎石取石术前预先留置输尿管双J管1周,可提高一次性放置软镜通道鞘成功率,并减少输尿管损伤等并发症的发生,手术更安全。

Objectives To evaluate the efficacy and safety of preoperative double J tube placement in flexible ureteroscopic lithotripsy. Methods From November 2014 to March 2015, 60 kidney stones or proximal ureter stones patients who were treated by flexible ureteroscopic lithotripsy, were randomly divided into group A and B. 30 case in Group A underwent directly surgery, 30 cases in group B indwelled a double J tube in ureter a week before the surgery. Both groups placed ureteral flexible ureteroscopic access sheath during the operation. The data were analyzed and compared. Results All 60 patients were successfully conducted transurethral flexible ureteroscopic lithotripsy. There were six patients had to dilateal the ureter before indwelling flexible ureteroscopic channel sheath in group A, while the Group B had 100% one-time success rates of indwelling flexible ureteroscopic channel sheath.（A vs B, 80% vs 100%, P〈0.05）. The stone-free rates in postoperative 1-2 days（A vs B, 60% vs 56.7%）, the stone-free rates in postoperative one month（A vs B, 96.7% vs 93.3%）, and the mean hospitalization costs had no significant difference between the two groups. The hospitalization duration of the two groups [A vs B,（6.7 ±1.7） days vs（11.7 ±3.7） days] had significant difference（P〈0.05）. One patient of group A appeared ureteral stone street after surgery, then was treated by ureteroscopic lithotripsy again. No severe complication occurred in both groups.Conclusions One week＇s preoperative double J tube placement is beneficial to facilitate flexible ureteroscopic lithotripsy with ureteral access sheath. It can reduce the incidence of ureteral injury.