软性输尿管镜钬激光碎石术后双J管放置时间的单中心随机对照研究

The optimal drainage duration of double J stent after holmium laser lithotripsy under flexible ureteroscopy:A randomized controlled single center study

目的:探讨软性输尿管镜钬激光碎石术后双J管的最佳留置时间。方法:采用随机对照的方法,选取248例肾结石患者,结石大小为(12.0±2.15)mm。所有患者均于术前留置双J管被动扩张输尿管2周后采用软性输尿管镜钬激光碎石术,术后常规留置F7号双J管。其中121例作为实验组,术后2周拔除双J管;127例作为对照组,术后4周拔除双J管。所有患者均于拔管后2周行泌尿系CT平扫检查,了解清石率。同时记录患者术后并发症的发生情况。结果:实验组的清石率为89.26%(108/121),对照组的清石率为88.19%(112/127),两组间清石率比较差异无统计学意义(P<0.05)。统计学研究发现,两组患者术后出现肉眼血尿、小腹胀痛、腰部胀痛等并发症差异无统计学意义(P>0.05),对照组术后出现尿路感染,膀胱刺激症状均明显高于实验组(P<0.05)。结论:软性输尿管镜术后2周和4周拔出双J管,清石率虽无明显差异,但双J管留置4周会明显增加术后泌尿系感染和膀胱刺激症状的发生率。

Objective:To explore the optimal indwelling time of double-J stent after flexible ureteroscopy. Methods:Using randomized controlled methods,248 patients with kidney stones were selected with the diameter of (12.0±2.15)mm.All patients were preseted double J tube to expand the ureter passively for two weeks.Then the renal stones were treated with flexible ureteroscopy and the F7 double J stent was placed in the ureter postoper-atively.In which,121 patients whose double J stent were removed at 2nd week postoperatively were assigned to experimental group,and 127 patients whose double J stent were removed at 4th week postoperatively were as-signed to control group.Computed tomography was done at 2nd week after the double-J stent being removed cys-toscopically to assess stone-free rate (SFR).Postoperative complications were recorded.Results:The SFR in the experimental group and control group was 89.26% (108/121)and 88.19% (112/127)respectively (P>0.05). Gross hematuria,abdomen pain,waist pain,urinary tract infection,irritation sign of bladder were recorded in two groups.There was no significant difference in gross hematuria,abdomen pain as well as waist pain between two groups (P>0.05).The incidence of postoperative complications as urinary tract infection and irritation sign of bladder was statistically higher in the control groups than that in the experimental group (P<0.05).Conclusions:The 4-week indwelling of double J stent may increase the incidence of urinary tract infection and irritation sign of bladder as compared with the 2-week indwelling although the SFR showed no statisticall significant difference.