输尿管导管引导下置入输尿管支架管在双镜同期治疗上尿路多处梗阻中的应用效果

Application effect of placement of ureteral stent guided by ureteral catheter in the double endoscopy simultaneous treatment of multiple upper urinary tract obstruction

目的探索输尿管镜及经皮肾镜联合治疗上尿路多处梗阻患者术中留置输尿管支架管的理想方法。方法选择2010年2月至2018年11月收治的96例上尿路多处梗阻患者,均行经尿道输尿管镜碎石取石术或扩张术,均在经尿道输尿管镜直视下逆行留置F5输尿管导管,并同期行经皮肾镜碎石取石术治疗。经统计,在术毕留置输尿管支架管时,其中40例采用输尿管导管引导下置入输尿管支架管,设为观察组;56例由尿道外口处拔出输尿管导管,由皮肾通道顺行置入斑马导丝,在斑马导丝引导下顺行置入输尿管支架管,设为对照组。观察两组患者置入输尿管支架管所需时间、术后输尿管支架管异位例数或者留置失败例数、术后发热例数及输尿管狭窄例数。结果观察组置入输尿管支架管所需时间显著短于对照组,差异具有统计学意义(P<0.05)。观察组输尿管支架管异位或留置失败率、术后发热率、术后输尿管狭窄率明显低于对照组,差异具有统计学意义(P<0.05)。结论对于行双镜同期治疗的上尿路多处梗阻患者,给予其输尿管导管引导下置入输尿管支架管,可尽量确保输尿管支架管顺利置入到理想位置,并可有效缩短手术时间,降低术后感染率及继发输尿管狭窄率。

Objective To explore the ideal method of intraoperative indwelling ureteral stent in multiple upper urinary tract obstruction patients treated with ureteroscopy and percutaneous nephroscopy.Methods Ninety-six patients with multiple upper urinary tract obstruction enrolled from February 2010 to November 2018 were selected and treated with transurethral ureteroscopic lithotripsy or dilatation,with F5 ureteral catheter placed retrogradely under the direct vision of transurethral ureteroscope,who were given percutaneous nephrolithotripsy at the same time.According to statistics,40 cases placed ureteral stent under the guidance of ureteral catheter were set as observation group;for another 56 cases,the ureteral catheter was pulled out from the external orifice of urethra,the zebra guide wire was placed anteriorly through the skin kidney channel,and the ureteral stent was placed anteriorly under the guidance of zebra guide wire,which set as control group.The time needed for the ureteral stent,the number of cases of ectopic or retention failure ureteral stent after operation,the numbers of cases of ectopia or retention failure of ureteral stenosis after operation were observed between the two groups.Results The time of ureteral stent placement in the observation group was significantly shorter than that in the control group,and the difference was statistically significant(P<0.05).The rate of ectopia or retention failure of ureteral stent,postoperative fever rate and postoperative ureteral stenosis rate in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion For the patients with multiple upper urinary tract obstruction treated by double endoscopy at the same time,the ureteral stent is placed under the guidance of ureteral catheter,which can ensure the ureteral stent to be placed in the ideal position as far as possible,and can effectively shorten the operation time,reduce the infection rate and secondary ureteral stenosis rate after operation.