输尿管镜治疗复杂性输尿管结石留置双J管时间的临床观察

Clinical observation of the double-J stent indwelling time in the treatment of ureteral complicated calculi post-ureteroscope

目的:探讨输尿管镜治疗复杂性输尿管结石术后留置双J管最佳时间。方法:回顾性分析2012年8月至2015年8月,采用输尿管镜配合钬激光治疗复杂性输尿管结石161例。按照术后留置双J管时间不同分为3组:<2周组(A组)43例;2~6周组(B组)67例;>6周组(C组)51例。比较各组置管相关并发症及拔管后肾积水加重情况,观察留置双J管的最佳时间。结果:C组总体置管相关并发症发生率显著高于A组、B组,差异具有统计学意义(P<0.017)。拔管后A组输尿管狭窄率为23.25%(10/43),高于B组[5.97%(4/67)]和C组[5.9%(3/51)],差异具有统计学意义(P<0.017),而B组与C组相比差异无统计学意义。结论:复杂性输尿管结石术后置管相关并发症随时间的延长而显著增加,而置管时间过短则发生输尿管狭窄概率增加,观察后认为术后最佳置管时间为2~6周。对于术中发现输尿管黏膜损伤严重者应适度延长双J管留置时间。

Objective To systematically evaluate the optimal indwelling time of double-J stent in thetreatment of ureteral complicated calculi post-ureteroscopy. Methods A total of 161 patients with complicatedureteral calculi were enrolled in this study from August 2012 to August 2015. All patients received the treatment ofureteroscopic holmium YAG Laser lithotripsy and were randomly divided into 3 groups according to varied double-J stent indwelling time： group A 2 weeks（n = 43）,group B from 2 ~ 6 weeks（n = 67）,and group C〉6 weeks（n = 51）. Complications of three groups were compared and the hydronephrosis after removing double-J stent wasrecorded. Results The rate of complications of group C was significantly higher than that in group A and group B（P〈 0.017）. However,group A（10/43）has a higher rate of ureterostenosis after removing double-J stent comparedwith group B（4/67）and group C（3/51）,while no statistical significance was observed between group B andgroup C. Conclusion The incidence of complications after lithotripsy increased with the indwelling time of double-Jstent,but the short indwelling time would led to ureterostenosis. Therefore,the optimal indwelling time of double-Jstent after flexible ureteroscopy was 2 to 6 weeks,and the indwelling time for patients with injury ureteral mucosacould be appropriately prolonged.