术前预置双J管在宫颈癌术后放疗前后拔管时机的临床分析

The clinical analysis of extubation of preoperative preset double J tube before or after postoperative adjuvant radiotherapy in early cervical cancer

目的:探讨术前预置双J管在宫颈癌术后辅助放疗前后拔管的临床意义。方法:回顾性分析中国医科大学附属盛京医院2013年2月至2014年12月103例宫颈癌(Ⅰ_(a2)-Ⅱ_(a2) 期)术前预置双J管后行根治性手术并术后辅助放疗患者的临床资料。其中63例宫颈癌患者于放疗开始前予以膀胱镜下取出双J管(实验组A),40例宫颈癌患者继续留置双J管至放疗中或放疗结束后(对照组B)。A、B两组就拔管前后置管相关并发症发生及改善情况(包括拔管后3月内在肾脏积水、肾小球率过滤、血清肌酐及尿素氮等方面)进行比较。结果:拔管前A、B两组均有置管相关并发症发生,B组并发症发生率显著高于A组(P<0.01),以尿路感染和发热最常见,A组并发症以结石最常见。在拔除双J管后,A、B两组置管并发症均自行消失或好转,且两组在肾脏积水、肾小球率过滤、血清肌酐等方面比较,差异无统计学意义(P>0.05),在血尿素氮方面比较,差异有统计学意义(P<0.05)。结论:宫颈癌术前预置双J管在术后放疗开始前拔管比放疗中及放疗结束后拔管并发症发生率更低,临床疗效无明显差异。

Objective: To investigate the clinical effect of extubation of preoperative preset double J tube before or after postoperative adjuvant radiotherapy in early cervical cancer. Methods: A retrospective analysis of 103 cervical cancer cases in Feb. 2013 to Dec. 2014( Ⅰ_(a2)-Ⅱ_(a2) period) was performed on the clinical data of Shengjing Hospital of China Medical University,in which patients underwent radical surgery with postoperative radiotherapy after preoperative preset double J tube. The 63 cases of cervical carcinoma patients underwent extubation of double J tube by cystoscope before radiotherapy( experimental group A),while the other 40 cases of cervical cancer patients continued indwelling of double J tube until radiotherapy or after radiotherapy( control group B). The two groups were compared in complications related to indwelling catheter before or after extubation and the improvement of conditions. It includes renal hydrops,glomerular filtration rate,serum creatinine and urea nitrogen 3 months after extubation. Results: Complications related to indwelling catheter occurred in both groups before extubation,while the occurrence of complications in group B was significantly higher than that of group A( P < 0. 01).( UTI) and( fever) is the most common complications in group B compared meanwhile( stone) was the most common complication in group A. After extubation,the complications were disappeared or improved in both groups. When compared in renal effusion,glomerular filtration rate,serum creatinine,two groups showed no statistically significance in difference( P > 0. 05). While the difference was statistically significant( P < 0. 05) in blood urea nitrogen. Conclusion: Extubation of preoperative preset double J tube in cervical cancer before preoperative radiotherapy shows lower incidence of complications than that in or after preoperative radiotherapy,and there is no obvious difference in the clinical efficacy.