预留双J管与球囊扩张在输尿管软镜碎石取石术中的比较

Comparative analysis of the efficacy of double J tube and balloon dilation in retrograde intrarenal surgery

目的对比分析术前预留双J管与球囊扩张在输尿管软镜碎石取石术(RIRS)应用中的安全性及疗效。方法回顾性分析2016年5月至2018年5月我院RIRS行单侧输尿管扩张125例,其中预留双J管被动扩张输尿管57例,一期球囊主动扩张输尿管68例,对两组病例一般资料及手术后数据进行统计分析。结果两组性别、年龄、结石部位、结石最大直径、多发结石数量差异无统计学意义(P>0.05)。预留双J管组留置16 F输尿管工作鞘(UAS)比例高于球囊扩张组(70.2%vs 30.9%,P<0.001),预留双J管组术后第一天疼痛评分较球囊扩张组低[(2.42±1.50)vs(3.82±1.92),P<0.001],两组一次性放置UAS成功率、手术时间、术后1~2 d结石清除率、总体结石清除率、术后住院时间及手术并发症等差异无统计学意义(P>0.05)。结论预留双J管与球囊扩张在RIRS应用中均安全、有效,具体采取哪种方式扩张输尿管取决于患者病情、医师水平、医院设备等。

Objective To compare the efficacy and safety of preoperative reserved double J catheter and balloon dilatation in the application of retrograde intra-renal surgery(RIRS).Methods Clinical data of 125 patients undergoing RIRS for unilateral ureteral dilatation in our hospital from May 2016 to May 2018 were retrospectively analyzed.Among them,57 patients received reserved double J catheter for passive ureteral dilatation and 68 cases underwent primary balloon for active ureteral dilatation.General data and postoperative data were statistically analyzed between two groups.Results No statistical difference was observed in gender,age,stone site,the maximum diameter of stones and the number of multiple stones between the two groups(all P>0.05).The proportion of retained 16 F ureteral access sheath(UAS)in the reserved double J catheter group was significantly higher than that in the balloon dilation group(70.2%vs 30.9%,P<0.001).The score of pain assessment at postoperative 1 d in the reserved double J catheter group was remarkably lower compared with that in the balloon dilation group[(2.42±1.50)vs(3.82±1.92),P<0.001].No statistical difference was observed in the success rate of one-stage UAS placement,operation time,stone clearance rate at postoperative 1-2 d,overall stone clearance rate,postoperative length of hospital stay and surgical complications between two groups(all P>0.05).Conclusion Reserved double J catheter and balloon dilatation are safe and effective in RIRS.The selection of ureteral dilatation approach depends on the physical conditions of patients,the expertise of physicians and hospital equipment,etc.