术前留置双J管在输尿管软镜钬激光碎石术中的应用效果

Application of preoperative indwelling double J tube in flexible ureterorenoscopy holmium laser lithotripsy

目的观察术前留置双J管在输尿管软镜(FURS)钬激光碎石术中的应用效果。方法选取2015年9月至2018年9月南阳南石医院泌尿外科收治的上尿路结石患者146例,采用随机数字表法将患者分为两组,每组73例。两组均进行FURS钬激光碎石术治疗,其中观察组术前常规留置双J管2周,对照组术前无特殊处理,比较两组手术效果及并发症发生情况。结果观察组手术时间和住院时间均少于对照组(P<0.05);观察组镜鞘置入成功率(97.26%,71/73)高于对照组(89.04%,65/73),差异有统计学意义(P<0.05)。两组一期结石清除率及术后疼痛程度比较差异未见统计学意义(P>0.05)。观察组术后输尿管壁伤损发生率(8.22%,6/73)低于对照组(20.55%,15/73),差异有统计学意义(P<0.05);两组输尿管壁损伤程度分级比较差异有统计学意义(P<0.05)。两组术后并发症发生率(17.81%比12.33%)及Clavien-Dindo分级比较差异未见统计学意义(P>0.05)。结论术前留置双J管2周对一期手术成功率无明显影响,但可有效缩短FURS钬激光碎石术手术时间并减少输尿管损伤发生率,有利于手术顺利完成和患者术后康复。

Objective To observe the application effect of preoperative indwelling double J tube in flexible ureterorenoscopy(FURS)holmium laser lithotripsy.Methods A total of 146 patients with upper urinary calculi admitted to Department of Urinary Surgery,Nanyang Nanshi Hospital from September 2015 to September 2018 were selected.The patients were divided into two groups by random number table method,with 73 cases in each group.Patients in both groups were treated by FURS holmium laser lithotripsy.The observation group was routinely indwelled with double J for 2 weeks before operation,while the control group had no special treatment before operation.The operation effect and complications were compared between the two groups.Results The operative time and hospital stay in observation group were significantly shorter than those in control group(P<0.05),and the success rate of scope lemma placement in observation group(97.26%,71/73)was significantly higher than that in control group(89.04%,65/73),P<0.05.There was no significant difference in the clearance rate of one-stage stones and postoperative pain between the two groups(P>0.05).The incidence of postoperative ureteral wall injury in the observation group(8.22%,6/73)was lower than that in the control group(20.55%,15/73),P<0.05;and there was a significant difference in the degree of ureteral wall injury between the two groups(P<0.05).There was no significant difference in the incidence of postoperative complications(17.81%vs.12.33%)or Clavien-Dindo classification between the two groups(P>0.05).Conclusions Preoperative double J tube indwelling for 2 weeks has no significant effects on the success rate of one-stage surgery,but it can effectively shorten the FURS holmium laser lithotripsy operative time and reduce the occurrence of ureteral injury,and it is conducive to the successful completion of surgery and postoperative rehabilitation.