输尿管内支架管简易拔除方法在儿童患者中的应用效果

Application of a novel procedure for removing ureteral stents in children

目的探讨一种非膀胱镜拔除儿童输尿管支架管方法的临床价值,总结拔管期间的诊疗经验。方法将310例接受上尿路手术的患儿随机分为两组。第1组150例患儿经膀胱镜拔除输尿管支架管;第2组160例患儿使用非膀胱镜方法拔除输尿管支架管,自制拔管器材为5号胃管前端侧孔处穿入单股缝线。患儿尿道内注入利多卡因凝胶,将胃管插入膀胱,旋转胃管720°,提拉缝线,同时将胃管一并拉出尿道,均能顺利取出内支架管。比较两组患者拔管成功率、拔管时间、拔管费用以及拔管后出血的发生情况。结果非膀胱镜拔管组患者中1例拔管不成功(成功率为99.9%),膀胱镜拔管组拔管成功率为100%,两组比较差异无统计学意义(P>0.05);男、女性患儿拔管时间膀胱镜拔管组分别为(14.5±0.5)min和(10.5±0.7)min,非膀胱镜拔管组分别为(4.5±1.0)min和(4.0±0.6)min,两组间比较具有统计学意义(P<0.05);非膀胱镜拔管组费用及拔管后血尿发生率明显低于膀胱镜组,两组间比较具有统计学意义(P<0.05)。结论非膀胱镜拔管法简单,可减轻患者接受侵入性操作的痛苦和经济负担,尤其在男性小儿病例中,具有一定的临床应用价值。

Objective To explore the clinical value of a novel non-cystoscopic procedure to remove ureteral stents in children and summarize the experience during extubation period. Methods A cohort of 310 children who underwent upper-urinary tract surgery were randomly divided into 2 groups： cystoscopic group （n = 150）, and non-cystoscopic group （n =160）. We used a simple self-made device in the non-cystoscopic group, which was made of an Fr5 feeding tube and a single strand suture. Tetracaine gel was injected into urethra for local anesthesia. Then the device was inserted into the bladder. Finally, the device was rotated for three rounds and the thread was pulled tight. The stent could be pulled out together with the device. The suc- cess rate of extubation, operation time, expenses and the incidence of bleeding after extubation were compared between the two groups. Results All cases in the cystoscopic group were successful, while 1 case in the non-cystoscopic group failed in pulling the tube, and the difference had no statistical significance （P〉0.05）. The mean operation time of non-cystoscopy group was significantly shorter than that of cystoscopy group [（4.5±1.0）min vs. （14.5 ± 0.5）min for boys] ; [（4.0±0.6）min vs. （10.5±0.7） min for girls]. The mean expenses and rate of hematuria after extubation in the non-cystoscopic group were significantly less than those in the cystoscopic group （P〈0.05）. Conclusion The non-cystoscopic procedure we have established is simple and easy to operate, which can alleviate the suffering of invasive operation and lessen the economic burden, especially for young boys, thus having high clinical value.