术前免预置双J管输尿管软镜碎石疗效分析

Analysis of the curative effect of preoperative double-J ureteroscope soft lithotripsy

目的探讨术前免预置双J管一期输尿管软镜碎石的可行性与临床疗效。方法于2016年1月～2017年12月对271例术前免预置双J管输尿管软镜碎石患者实施输尿管软镜碎石术,统计一期手术成功率;结石碎石清除率及并发症发生情况。结果 271例患者一次性软镜鞘置入并一期手术成功,成功率为93%(252/271)。术后3d所有患者常规泌尿系CT平扫复查,结石负荷均有明显的减轻,术后一月拔除双J管,术后2月复查结石清除率达到91%(247/271)。271例术后出现不同程度的肉眼血尿,其中260例于术后48h内自行停止,一例患者较为严重的血尿予以绝对卧床止血药物应用等保守治疗后3～4d出血停止。另本组3例患者术后发热,诊断为尿脓毒血症,其中的2例发展为感染性休克,在ICU抗感染抗休克治疗后痊愈。271例患者的术后平均住院时间为(1.7±0.3)d,手术时间平均为(37.6±6.0)min。271例患者的住院费用平均为(15655.32±133.54)元。结论术前免预置双J管一期输尿管软镜碎石技术安全可行,可以减少术前放置双J管对患者的身心创伤和治疗成本。

Objective To investigate the feasibility and clinical effect of preoperative non-preset soft ureteroscope lithotripsy with double J tubes. Methods 271 cases of ureteroscopic lithotripsy with double J tube ureteroscopic lithotripsy from January 2016 to December 2017, were performed before operation. The success rate of the first stage operation, the removal rate of stone lithotripsy and the occurrence of complications were observed. Results 271 patients were successfully treated with one time flexible lens sheath operation and the success rate was 93%(252/271). CT scan showed that the stone load of the patients was relieved obviously 3 days after the operation. The double J tube was removed one month after the operation, and the stone clearance rate reached 91%(247/271) 2 months after the operation. There were 271 cases of macroscopic hematuria with varying degrees postoperatively, among which 260 cases stopped spontaneously within 48 hours after surgery, and one case of severe hematuria stopped bleeding 3-4 days after conservative treatment such as application of absolute bed rest hemostatic drugs. Another 3 patients in this group had postoperative fever, which was diagnosed as urinary sepsis, and 2 of them developed septic shock, which was cured after anti-infective and anti-shock treatment in ICU. The mean postoperative hospitalization time of the 271 patients was (1.7±0.3) days, and the mean operative time was (37.6±60) min. The average hospitalization cost of 271 patients was 15655.32±133.54 yuan. Conclusion It is safe and feasible to avoid pre-set double-j tube and first-stage ureteroscope soft lithotripsy before operation, which can reduce the physical and mental trauma and treatment cost of patients before operation.