术后支架置入时间对输尿管软镜碎石术治疗肾结石结局的影响分析

Effect of postoperative stent placement time on the outcome of flexible ureteroscope lithotripsy in the treatment of kidney calculi

目的探讨术后支架置入时间对输尿管软镜碎石术(FURL)治疗肾结石结局的影响。方法回顾性分析2017年4月-2018年11月广元市中心医院收治的126例肾结石患者,患者均采用FURL治疗。按照FURL术后支架置入时间的不同将患者分为两组:常规置管组(n=91)和短期置管组(n=35)。常规置管组患者的术后支架置入时间为4周,短期置管组患者的术后支架置入时间为2周。比较两组患者的术后结局指标(住院时间和无石率)、术后并发症指标(术后血尿、肾血肿、尿路感染和发热)和术后疼痛情况。计量资料以均数±标准差(Mean±SD)表示,组间比较采用Student′s t检验;计数资料组间比较采用χ^2检验。结果常规置管组和短期置管组的住院时间[(7.22±1.02)d比(7.26±1.22)d]、术后1个月无石率[84.6%比82.8%]、术后2个月无石率[93.4%比88.5%]、术后血尿[10.9%比11.4%]、肾血肿[3.3%比0]和发热情况[2.2%比0]比较,差异均无统计学意义(P>0.05);相对于常规置管组,短期置管组患者的尿路感染率更低[17.6%比2.9%],差异具有统计学意义(P<0.05)。住院期间,常规置管组和短期置管组的阿片类药物平均应用次数[(1.05±0.45)次比(1.00±0.50)次]、对乙酰氨基酚和非甾体类消炎药(NSAIDs)应用次数[(1.52±0.55)次比(1.45±0.45)次]比较,差异无统计学意义(P>0.05)。出院后1个月,两组患者的腹痛发生次数[(1.25±0.55)次比(1.15±0.45)次]比较,差异无统计学意义(P>0.05);常规置管组患者的对乙酰氨基酚和NSAIDs应用次数大于短期置管组[(1.45±0.46)次比(1.25±0.30)次],差异具有统计学意义(P<0.05)。结论在肾结石FURL手术后,使用短期支架置入术与传统的长期支架置入术一样有效,可以达到同样的无石效果,并减少术后早期并发症。对于降低术后感染和术后疼痛,短期支架置入术具有一定的优势。

Objective To explore the effect of postoperative stent placement time on flexible ureteroscopy lithotripsy(FURL)in the treatment of kidney calculi.Methods A retrospective analysis of 126 patients with kidney calculi admitted to Guangyuan Central Hospital from April 2017 to November 2018.All patients were treated with FURL.The patients were divided into two groups according to the time of stent placement after FURL:conventional tube placement group(n=91)and short-term tube placement group(n=35).The postoperative stent placement time of patients in the conventional tube placement group was 4 weeks,and the postoperative stent placement time of patients in the short-term tube placement group was 2 weeks.The postoperative outcome indicators(hospitalization time and stone-free rate),postoperative complication indicators(postoperative hematuria,renal hematoma,urinary tract infection and fever)and postoperative pain were compared between the two groups.The measurement data was expressed as mean±standard deviation(Mean±SD),and the Student′s t test was used for comparison between groups;the Chi-square test was used for comparison between counting data.Results There were not significant differences in hospitalization time[(7.22±1.02)d vs(7.26±1.22)d],stone-free rate 1 month after surgery(84.6%vs 82.8%),stone-free rate 2 month after surgery(93.4%vs 88.5%),postoperative hematuria(10.9%vs 11.4%),renal hematoma(3.3%vs 0)and fever(2.2%vs 0)between the conventional tube placement group and short-term tube placement group(P>0.05).Compared with the conventional tube placement group,the short-term tube group had lower urinary tract infection rates(17.6%vs 2.9%),the difference was statistically significant(P<0.05).There was not significant difference in the average use rate of opioids[(1.05±0.45)vs(1.00±0.50),P>0.05],acetaminophen and nonsteroidal anti-inflammatory drugs(NSAIDs)[(1.52±0.55)vs(1.45±0.45),P>0.05]between the two groups during hospitalization.There was not statistically significant difference in the incidence of abdominal pain after discharge from the hospital[(1.25±0.55)vs(1.15±0.45)].The number of applications of acetaminophen and NSAIDs in the conventional tube placement group was greater than that in the short-term tube placement group[(1.45±0.46)vs(1.25±0.30)]after one month,the difference was statistically significant(P<0.05).Conclusions Short-term tube placement after renal FURL surgery is as effective as traditional long-term stenting,achieving the same stone-free effect and reducing early postoperative complications.For the reduction of postoperative infection and postoperative pain,short-term stenting has certain advantages.