双J管留置时间对输尿管结石患者感染治疗效果的影响研究

Effect of double-J stent indwelling time on treatment of ureteral calculi patients complicated with infection

目的探讨双J管留置时长对输尿管结石并发感染患者治疗效果的影响,为临床应用提供参考依据。方法选取2012年1月-2016年3月医院收治的123例输尿管结石并发感染患者为研究对象,入院后首先在输尿管硬镜下置入双J管,后行输尿管镜下钬激光碎石术或经皮肾镜碎石术清除结石;根据双J管留置时长分为7d组(58例)与>7d组(65例),比较两组的基线资料及手术资料。结果共检出病原菌33株,其中革兰阴性菌感染最多,占66.7%;两组患者性别、年龄、体质指数、病程、体温、血、尿白细胞(WBC)计数等基线资料相比,差异无统计学意义,具有可比性;两组患者留置双J管当天的尿WBC计数、留置第7天的血、尿WBC计数及发热等资料相比,差异无统计学意义;两组患者的手术时间、手术方式、术后住院时间、术后30d的结石清除率、术后并发症发生率及Clavien-Dindo分级等手术资料比较,差异无统计学意义。结论双J管留置时长对输尿管结石并发感染患者的治疗效果和安全性无显著影响,建议尽可能在留置7d后拔除,尽早进行结石手术。

OBJECTIVE To explore the effect of double-J stent indwelling time in treatment of ureteral calculi patients complicated with infection so as to provide guidance for clinical application.METHODS A total of 123 ureteral calculi patients complicated with infection who were treated in hospitals from Jan 2012 to Mar 2016 were recruited as the study objects,the patients firstly received the double-J stent indwelling via rigid ureteroscope after admission and then underwent the ureteroscopic holmium laser lithotripsy or percutaneous nephrolithotomy for removal of stones.The enrolled patients were divided into the 7-day group with 58 cases and the more than 7-day group with 65 cases according to the indwelling time of double-J stent.The baseline data and surgical data were compared between the two groups of patients.RESULTS Totally 33 strains of pathogens were isolated,of which66.7% were gram-negative bacteria.As compared with the baseline data,there was no significant difference in the gender,age,body mass index,disease course,body temperature,or blood,urine white blood cell（WBC）counts between the two groups of patients,which was comparable.There was no significant difference in the urine WBC counts on right day of double-J stent indwelling,blood,urine WBC counts on day 7of indwelling,or fever between the two groups of patients.As compared with the surgical data,there was no significant difference in the operation duration,surgical approach,postoperative hospitalization duration,clearance rate of stones 30 days after the surgery,incidence of postoperative complications,or Clavien-Dindo grading between the two groups of patients.CONCLUSIONThe indwelling time of double-J stent does not have significant impact on therapeutic effect and safety of the ureteral calculi patients complicated with infection.It is suggested that the double-J stent should be removed after 7days of indwelling and carry out the stone surgery as early as possible.