输尿管镜术后留置双J管并发血尿的原因分析及对策

Cause analysis and countermeasures of hematuria complicated by indwelling double J tube after ureteroscopy

目的探讨输尿管镜术后留置双J管并发血尿的原因并提出相应对策。方法纳入320例输尿管镜术后留置双J管的患者(输尿管上段结石66例,中段结石88例,下段结石144例,输尿管狭窄22例)为研究对象,分析不同类型患者术后1个月随访时出现血尿的情况,总结出现血尿的原因并提出相应的预防对策。结果术后1个月,66例输尿管上段结石患者出现重度血尿48例,占72.73%;88例输尿管中段结石患者出现重度血尿42例,占47.73%;144例输尿管下段结石患者出现中重度血尿24例,占16.67%;22例输尿管狭窄患者无中重度血尿发生。输尿管上段结石、中段结石、下段结石及输尿管狭窄患者术后中重度血尿发生率依次降低(均P<0.05)。结论术后尿路感染、碎石时输尿管受损黏膜与双J管摩擦、留置的双J管尾端刺激膀胱三角区、人体组织对双J管的异物反应是术后血尿发生的主要原因。术后感染的控制、手术技巧的提高、输尿管镜及双J管的合理选择、合理用药是减少输尿管镜术后留置双J管并发血尿的关键。

Objective To investigate the causes for hematuria complicated by indwelling double J tube after ureteroscopy and to propose corresponding countermeasures.Methods A total of 320 patients with indwelling double J tube after ureteroscopy(66 cases of upper ureteral calculus,88 cases of middle ureteral calculus,144 cases of lower ureteral calculus,22 cases of ureteral stricture)were included as research objects to analyze the occurrence of hematuria at 1-month postoperative follow-up in different types of patients,summarize the causes for the occurrence of hematuria and propose corresponding preventive countermeasures.Results One month after operation,48 cases of 66 patients with upper ureteral calculus had severe hematuria,accounting for 72.73%.Among 88 patients with middle ureteral calculus,42 cases had severe hematuria,accounting for 47.73%.Among 144 patients with lower ureteral calculus,24 cases had moderate to severe hematuria,accounting for 16.67%.No moderate or severe hematuria occurred in the 22 patients with ureteral strictures.The incidence of moderate and severe hematuria decreased in patients with upper ureteral calculus,middle ureteral calculus,lower ureteral calculus,and ureteral stricture successively after operation(all P<0.05).Conclusion The main causes of postoperative hematuria were postoperative urinary tract infection,the friction of ureteral mucosa injured in lithotripsy against the double J tube,the stimulation of the bladder trigone by the tail of the retained double J tube,and the foreign body reaction of human tissue to the double J tube.The control of postoperative infection,improvement of surgical skills,reasonable selection of ureteroscope and double J tube and rational use of drugs are the key points to reduce the occurrence of hematuria in patients with indwelling double J tube after ureteroscopy.