逆行留置输尿管导管与留置双J管对经皮肾镜碎石术的安全有效性的对比研究及临床体会

Comparative study and clinical experience of retrograde indwelling ureteralcatheter and indwelling double J tube for percutaneous nephrolithotomy

目的:对比研究术前经膀胱镜留置输尿管导管或留置双J管制造人工肾积水对经皮肾镜碎石术的安全有效性的影响。方法:回顾分析2017年1月-2017年12月接受PCNL手术的157例患者的临床资料,其中逆行留置F5输尿管导管89例(A组),逆行留置F4.7双J管68例(B组)。比较两组患者在通道建立时间、手术时间、有无肾脏出血、结石清除率、术后肾功能变化、术后血红蛋白变化等指标的差异。结果:两组患者在通道建立时间、手术时间、有无肾脏出血、结石清除率、术后肾功能变化、术后血红蛋白变化等指标差异无统计学意义(P>0.05)。结论:经皮肾镜术前留置输尿管导管与留置双J管制造人工肾积水对经皮肾镜碎石术的安全有效性无明显影响,差异无统计学意义。且术前留置双J管可相对缩短手术时间,给与术者在穿刺入路上更多的选择,降低感染风险,提高双J管留置成功率。故可以在临床上提倡以术前留置双J管代替留置输尿管导管。

objective:To compare the effect of ureteral catheter indwelling or double J catheter indwelling through cystoscope before percutaneous nephrolithotomy on the safety and effectiveness of percutaneous nephrolithot?omy.Methods:The clinical data of 157 patients underwent PCNL from January 2017 to December 2017 were retro?spectively analyzed. Among them,89 cases were retrograde indwelling F5 ureteral catheter(group A)and 68 cases were retrograde indwelling F4.7 double J catheter(group B). The differences in the parameters such as channel estab?lishment time,operation time,renal hemorrhage(or not),stone clearance rate,postoperative renal function chang?es,and postoperative hemoglobin changes were compared between the two groups.Results:There was no significant differences between the two groups in the time of establishing the channel,the time of operation,the condition of re?nal hemorrhage,the rate of stone clearance,the changes of renal function and hemoglobin after operation(P>0.05).Conclusion:Indwelling F5 ureteral catheter and indwelling double J tube for artificial hydronephrosis have no signifi?cant effect on the safety and efficacy of percutaneous nephrolithotomy,the differences is not statistically significant.The preoperative indwelling of double J tube can shorten the operation time,give the surgeon more choices on the puncture path,reduce the risk of infection,and improve the success rate of double J tube indwelling. Therefore,it can be advocated that double J catheter should be placed before operation instead of indwelling ureteral catheter.