输尿管支架管辅助治疗肾结核的疗效分析

Clinical Efficacy Analysis of Ureteral Stent Assisted Treatment of Renal Tuberculosis

目的探讨输尿管支架管在肾结核辅助治疗中的应用价值。方法回顾性分析2012年7月~2019年9月100例肾结核诊治资料,均行规范的抗结核治疗,其中50例输尿管内留置双J管引流肾积水,50例因拒绝外科干预未留置双J管。对比2组治疗前及治疗18个月后临床指标的差异。结果①2组血肌酐治疗前后及组间差异无统计学意义(P>0.05)。②留置双J管的50例治疗后18个月肾盂分离度减轻[(27.2±8.1)vs.(12.7±4.1)mm,t=16.679,P=0.000],患侧肾小球滤过率(GFR)、肾实质厚度较治疗前差异无统计学意义(P>0.05)。40例临床治愈,10例肾切除。③未留置双J管的50例治疗后18个月患侧GFR降低[(30.4±5.8)vs.(16.5±5.3)ml/min/1.73m2,t=27.760,P=0.000],肾盂分离度增加[(27.1±7.8)vs.(34.9±5.5)mm,t=-13.646,P=0.000],肾实质厚度减小[(20.0±3.5)vs.(11.3±3.8)mm,t=23.452,P=0.000]。21例临床治愈,29例肾切除。④治疗前2组患侧GFR、肾盂分离度、肾实质厚度差异无统计学意义(P>0.05),治疗18个月置管组较未置管组患侧GFR高(t=11.524,P=0.000),肾盂分离度小(t=-22.894,P=0.000),肾实质厚度大(t=11.410,P=0.000),肾切除率低(χ^2=15.174,P=0.000),临床治愈率高(χ^2=15.174,P=0.000)。但置管组新发肉眼血尿发生率高[76.7%(23/30)vs.18.4%(7/38),χ^2=23.069,P=0.000]。2组新发膀胱结核、发热差异无统计学意义(P>0.05)。结论留置双J管辅助治疗肾结核,能减轻肾积水和肾实质损害,保留肾功能,降低肾切除率,提高临床治愈率。

Objective To explore the clinical value of ureteral stent in the adjuvant treatment of renal tuberculosis.Methods A retrospective analysis was made on 100 cases of renal tuberculosis from July 2012 to September 2019 who received standard anti-tuberculosis treatment,including 50 cases with indwelled double J tube in ureter to drainage hydronephrosis and 50 cases without indwelling double J tube because of refusal of surgical intervention.The differences of clinical indexes were compared between the two groups before and after 18 months of treatment.Results There was no statistical difference in serum creatinine between the two groups and before and after treatment(P>0.05).In the catheterization group,there were no significant differences in glomerular filtration rate(GFR)and renal parenchyma thickness before and after treatment(P>0.05).The degree of renal pelvis separation was reduced[(27.2±8.1)vs.(12.7±4.1)mm,t=16.679,P=0.000].There were 40 cured cases and 10 cases of nephrectomy.In the non-catheterization group,the GFR was decreased[(30.4±5.8)vs.(16.5±5.3)ml/min/1.73 m2,t=27.760,P=0.000],renal pelvis separation increased[(27.1±7.8)vs.(34.9±5.5)mm,t=-13.646,P=0.000],and renal parenchyma thickness decreased after 18 months of treatment[(20.0±3.5)vs.(11.3±3.8)mm,t=23.452,P=0.000].A total of 21 cases were clinically cured,and 29 cases were given nephrectomy.There was no significant difference in GFR,renal pelvis separation and renal parenchyma thickness between the two groups before treatment(P>0.05).After 18 months of treatment,the GFR was higher(t=11.524,P=0.000),the degree of separation of renal pelvis was smaller(t=-22.894,P=0.000),the thickness of renal parenchyma was larger(t=11.410,P=0.000),the rate of nephrectomy was lower(χ^2=15.174,P=0.000),and the clinical cure rate was higher(χ^2=15.174,P=0.000)in the catheterization group than those in the non-catheterization group.But the incidence of new-onset gross hematuria was higher in the catheterization group[76.7%(23/30)vs.18.4%(7/38),χ^2=23.069,P=0.000].There was no significant difference in new-onset bladder tuberculosis,fever and other complications(P>0.05).ConclusionIndwelling double J tube can reduce hydronephrosis and renal parenchyma damage,preserve renal function,reduce nephrectomy rate and improve clinical cure rate.