宫颈癌术后补充放疗患者预置输尿管支架改善泌尿系统并发症的临床研究

Study of indwelling double J tube in improving urinary tract complications in patients with postoperative treatment after cervical cancer surgery

目的分析预置输尿管支架对宫颈癌术后补充放疗患者降低泌尿系梗阻发生率和保护肾功能的临床应用价值。方法宫颈癌(ⅠA期、ⅠB期和ⅡA期)患者81例,分为2组。观察组39例于放疗定位前预置输尿管支架并带管放疗;对照组42例采用常规补充放疗,不预置输尿管支架。观察2组肾积水、肌酐、尿素氮情况,记录包括发热、感染、腰痛、肾区叩击痛、放射性膀胱炎等与留置输尿管支架相关并发症的发生率。结果观察组肾积水总发生率(10.3%vs.33.3%)和轻度肾积水发生率(5.1%vs.21.4%)少于对照组(P<0.05);2组中度和重度肾积水发生率差异无统计学意义;治疗后观察组肌酐水平[(116.9±43.0)μmol/L vs.(170.8±68.4)μmol/L]和尿素氮水平[(5.4±1.9)mmol/L vs.(7.7±2.5)mmol/L]均低于对照组(P<0.05),且除观察组尿素氮外,2组治疗前后肌酐和尿素氮差异均有统计学意义(P<0.05)。观察组留置输尿管支架期间发热、感染、腰痛、肾区叩击痛和放射性膀胱炎发生率与对照组差异均无统计学意义。结论对宫颈癌术后补充放疗患者预置输尿管支架可以防治输尿管梗阻,保护肾功能,该方法有效、安全、可行,具有较高的临床应用价值。

Objective To analyze the clinical application value of double J tube in the protection of renal function andthe relief of urinary tract obstruction in patients with postoperative treatment after cervical cancer surgery. Methods Therewere 81 patients with cervical cancer(stage ⅠA & ⅠB & ⅡA) selected in our hospital from June 2013 to June 2016 whowere treated with postoperative radiotherapy. Patients were divided into observation group(indwelling double J tube group,n=39) and control group(conventional treatment group, n=42). After the treatment, data of hydronephrosis, creatinine andurea nitrogen were compared between the two groups. Data of complications associated with indwelling ureteral stentincluding fever, infection, low back pain, percussion pain in renal region and radiation cystitis were recorded. Results Thetotal incidence rate of hydronephrosis(10.3% vs. 33.3%) and the incidence of mild renal hydrocephalus(5.1% vs. 21.4%)were less in observation group than those in the control group(P<0.05). There were no significant differences in incidencerates of hydronephrosis and mild renal hydrocephalus between the two groups. The levels of creatinine[(116.9±43.0) μmol/L vs.(170.8±68.4) μmol/L]and urea nitrogen[(5.4±1.9) mmol/L vs.(7.7±2.5) mmol/L]were lower in the observation group thanthose in the control group(P<0.05). Except for the urea nitrogen of the observation group, there were significant differencesin creatinine and urea nitrogen before and after treatment between two groups(P<0.05). During the indwelling of the doubleJ tube, there were no significant differences in the incidences of fever, infection, lumbago, renal percussion pain andradiation cystitis between observation group and control group(P>0.05). Conclusion It is effective, safe and feasible toprevent ureteral obstruction and protect renal function by indwelling double J tube in patients with postoperative treatmentafter cervical cancer surgery.