术前未预置双J管一期输尿管软镜碎石治疗上尿路结石的疗效观察
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摘要
目的探讨术前免留双J管一期输尿管软镜治疗上尿路结石的临床疗效。方法选择2015年4月-2017年6月在该院住院行输尿管软镜碎石的296例上尿路结石患者,随机分成两组。观察组术前不留置双J管一期行输尿管软镜碎石治疗,对照组术前留置双J管一周后行输尿管软镜碎石治疗。统计并分析两组患者的临床资料和手术相关数据。结果该研究的所有患者均成功行输尿管软镜碎石取石术,观察组一次性置鞘的成功率为89.19%,对照组成功率为96.62%,差异有统计学意义(P <0.05);观察组和对照组治疗费用分别是(20 161.02±579.52)和(21 340.16±732.64)元,差异有统计学意义(P <0.05);术后1个月清石率观察组是89.87%,对照组是93.92%,差异无统计学意义(P>0.05);观察组和对照组患者术后出现留置双J管引起的并发症的发生率分别是28.38%(42/148)和22.30%(33/148),差异无统计学意义(P>0.05)。两组患者均未出现脓毒血症、感染性休克、肾绞痛、输尿管石街和输尿管狭窄等严重并发症。结论术前未提示输尿管狭窄的患者,不预留双J管一期行输尿管软镜碎石治疗也具有较高的清石率,且能减少双J管留置期间带来的不适症状,减轻患者痛苦和经济负担。
Objective To investigate the clinical efficacy of stage I flexible ureteroscopic lithotripsy in treatment of upper urinary calculi without preexistent double J tube. Methods From April 2015 to June 2017, 296 upper urinary stones patients who were treated by flexible ureteroscopic lithotripsy were randomly divided into two groups. The observation group directly surgery without preexistent double J tube, the control group indwelled a double J tube a week before the operation. The clinical data and surgical data of the two groups were statistically analyzed. Results All the patients in this study were successfully treated with flexible ureteroscopic lithotripsy. The success rate of sheath placement was 89.19% in the observation group. The success rate in the control group was96.62%(P < 0.05). The treatment cost of the two groups was(20 161.02 ± 579.52) yuan and(21 340.16 ± 732.64)yuan in observation group and control group respectively, but there was no significant difference(P < 0.05). The stone-free rates in postoperative one month was 89.87% in the observation group, it was 93.92% in control group,there was no difference between the two groups(P > 0.05). Incidence of complication after operation that caused by double J tube placement in observation group and control group is 28.38%(42/148) and 22.30%(33/148)(P > 0.05). Sepsis, septic shock, renal colic, ureteral calculus, ureteral stenosis and other complications no occurred in the two groups. Conclusion Without placement preexistent ureteral stentin also had higher stone clearance rate before flexible ureteroscopic, and could reduce the discomfort caused by double J tube placement, alleviate pain and economic burden of patients.
Objective To investigate the clinical efficacy of stage I flexible ureteroscopic lithotripsy in treatment of upper urinary calculi without preexistent double J tube. Methods From April 2015 to June 2017, 296 upper urinary stones patients who were treated by flexible ureteroscopic lithotripsy were randomly divided into two groups. The observation group directly surgery without preexistent double J tube, the control group indwelled a double J tube a week before the operation. The clinical data and surgical data of the two groups were statistically analyzed. Results All the patients in this study were successfully treated with flexible ureteroscopic lithotripsy. The success rate of sheath placement was 89.19% in the observation group. The success rate in the control group was96.62%(P < 0.05). The treatment cost of the two groups was(20 161.02 ± 579.52) yuan and(21 340.16 ± 732.64)yuan in observation group and control group respectively, but there was no significant difference(P < 0.05). The stone-free rates in postoperative one month was 89.87% in the observation group, it was 93.92% in control group,there was no difference between the two groups(P > 0.05). Incidence of complication after operation that caused by double J tube placement in observation group and control group is 28.38%(42/148) and 22.30%(33/148)(P > 0.05). Sepsis, septic shock, renal colic, ureteral calculus, ureteral stenosis and other complications no occurred in the two groups. Conclusion Without placement preexistent ureteral stentin also had higher stone clearance rate before flexible ureteroscopic, and could reduce the discomfort caused by double J tube placement, alleviate pain and economic burden of patients.
引文
[1]杨敏龙.输尿管软镜碎石术前是否留置双J管的随机对照临床试验[D].广东:广州医科大学, 2014.[1]YANG M L. Randomized controlled clinical trials of double J tubes were retained before ureteroscopic lithotripsy[D]. Guangdong:Guangzhou Medical University, 2014. Chinese
[2]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社, 2014:254-256.[2]NA Y Q, YE Z Q, SUN Y H, et al. Guidelines for diagnosis and treatment of urological diseases in China(2014 edition)[M].Beijing:People’s Medical Publishing House, 2014:254-256.Chinese
[3]杨炜青,李逊,何永忠,等.输尿管软镜碎石术前留置双J管的随机对照研究[J].中华腔镜泌尿外科杂志:电子版, 2016,10(2):26-29.[3]YANG W Q, LI X, HE Y Z, et al. A randomized controlled study on preoperative double J tube placement in flexible ureteroscopic lithotripsy[J]. Chinese Journal of Endoscopic Urology:Electronic Edition, 2016, 10(2):26-29. Chinese
[4]段康,刘齐贵,王跃力,等.双J管预扩张输尿管软镜治疗肾结石363例疗效分析[J].中国微创外科杂志, 2015, 15(8):692-694.[4]DUAN K, LIU Q G, WANG Y L, et al. Efficacy of preoperative ureteral stenting in flexible ureteroscopy for renal calculi:report of 363 cases[J]. Chinese Journal of Minimally Invasive Surgery,2015, 15(8):692-694. Chinese
[5]DOIZI S, TRAXER O. Re:evaluation of a novel single-use flexible ureteroscope[J]. European Urology, 2017, 72(1):152-153.
[6]蒋立量,杨嗣星.输尿管通达鞘及其临床应用[J].微创泌尿外科杂志, 2017, 6(2):124-128.[6]JIANG L L, YANG S X. The ureteral access sheath and its clinical practice in flexible ureteroscopy[J]. Journal of Minimally Invasive Urology, 2017, 6(2):124-128. Chinese
[7]TRAXER O, THOMAS A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery[J]. J Urology, 2013,189(2):580-584.
[8]AMBANI S N, FAERBER G J, ROBERTS W W, et al. Ureteral stents for impassable ureteroscopy[J]. Journal of Endourology,2013, 27(5):549-553.
[9]张军,刘佳,赵纪宇,等.输尿管软镜碎石术预置输尿管支架必要性的探讨[J].中国医刊, 2017, 52(3):30-31.[9]ZHANG J, LIU J, ZHAO J Y, et al. Discussion on necessity of prefabricating ureteral stent by flexible ureteroscope lithotripsy[J].Chinese Journal of Medical, 2017, 52(3):30-31. Chinese
[10]ASSIMOS D, KRAMBECK A, MILLER N L, et al. Surgical management of stones:American Urological Association/Endourological Society Guideline, PART I[J]. Journal of Urology,2016, 196(4):1153-1160.
[11]SHIELDS J M, BIRD V G, GRAVES R, et al. Impact of preoperativeureteralstentingonoutcomeofureteroscopic treatment for urinary lithiasis[J]. Journal of Urology, 2009,182(6):2768-2774.
[12]蔡万松,蒋祥新,闻立平.术前免留置双J管一期输尿管软镜治疗肾结石的临床研究[J].中国内镜杂志, 2016, 22(4):58-62.[12]CAI W S, JIANG X X, WEN L P. Clinical application of flexible ureteroscopy lithotripsy in treatment of renal calculi without preexistent ureteral stent[J]. China Journal of Endoscopy, 2016,22(4):58-62. Chinese
[13]DESSYN J F, BALSSA L, CHABANNES E, et al. Flexible ureterorenoscopy for renal and proximal ureteral stone in patients with previous ureteral stenting:impact on stone-free rate and morbidity[J]. Journal of Endourology, 2016, 30(10):1084-1088.
[14]LUMMA P P, SCHNEIDER P, STRAUSS A, et al. Impact of ureteral stenting prior to ureterorenoscopy on stone-free rates and complications[J]. World Journal of Urology, 2013, 31(4):855-859.
[15]ASSIMOS D, CRISCI A, CULKIN D, et al. Preoperative JJ stent placement in ureteric and renal stone treatment:results from the Clinical Research Office of Endourological Society(CROES)ureteroscopy(URS)global study[J]. BJU Int, 2016, 117(4):648-654.
[16]刘可,肖春雷,刘余庆,等.标准化技术输尿管软镜钬激光碎石术治疗输尿管近端及肾结石:单中心140例报告[J].中国微创外科杂志, 2015, 15(12):1065-1068.[16]LIU K, XIAO C L, LIU Y Q, et al. Management of intrarenal and proximalureteralstonesbystandardizedflexibleureteroscopic holmium laser lithotripsy:a single center experience from 140cases[J]. Chinese Journal of Minimally Invasive Surgery, 2015,15(12):1065-1068. Chinese
[2]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社, 2014:254-256.[2]NA Y Q, YE Z Q, SUN Y H, et al. Guidelines for diagnosis and treatment of urological diseases in China(2014 edition)[M].Beijing:People’s Medical Publishing House, 2014:254-256.Chinese
[3]杨炜青,李逊,何永忠,等.输尿管软镜碎石术前留置双J管的随机对照研究[J].中华腔镜泌尿外科杂志:电子版, 2016,10(2):26-29.[3]YANG W Q, LI X, HE Y Z, et al. A randomized controlled study on preoperative double J tube placement in flexible ureteroscopic lithotripsy[J]. Chinese Journal of Endoscopic Urology:Electronic Edition, 2016, 10(2):26-29. Chinese
[4]段康,刘齐贵,王跃力,等.双J管预扩张输尿管软镜治疗肾结石363例疗效分析[J].中国微创外科杂志, 2015, 15(8):692-694.[4]DUAN K, LIU Q G, WANG Y L, et al. Efficacy of preoperative ureteral stenting in flexible ureteroscopy for renal calculi:report of 363 cases[J]. Chinese Journal of Minimally Invasive Surgery,2015, 15(8):692-694. Chinese
[5]DOIZI S, TRAXER O. Re:evaluation of a novel single-use flexible ureteroscope[J]. European Urology, 2017, 72(1):152-153.
[6]蒋立量,杨嗣星.输尿管通达鞘及其临床应用[J].微创泌尿外科杂志, 2017, 6(2):124-128.[6]JIANG L L, YANG S X. The ureteral access sheath and its clinical practice in flexible ureteroscopy[J]. Journal of Minimally Invasive Urology, 2017, 6(2):124-128. Chinese
[7]TRAXER O, THOMAS A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery[J]. J Urology, 2013,189(2):580-584.
[8]AMBANI S N, FAERBER G J, ROBERTS W W, et al. Ureteral stents for impassable ureteroscopy[J]. Journal of Endourology,2013, 27(5):549-553.
[9]张军,刘佳,赵纪宇,等.输尿管软镜碎石术预置输尿管支架必要性的探讨[J].中国医刊, 2017, 52(3):30-31.[9]ZHANG J, LIU J, ZHAO J Y, et al. Discussion on necessity of prefabricating ureteral stent by flexible ureteroscope lithotripsy[J].Chinese Journal of Medical, 2017, 52(3):30-31. Chinese
[10]ASSIMOS D, KRAMBECK A, MILLER N L, et al. Surgical management of stones:American Urological Association/Endourological Society Guideline, PART I[J]. Journal of Urology,2016, 196(4):1153-1160.
[11]SHIELDS J M, BIRD V G, GRAVES R, et al. Impact of preoperativeureteralstentingonoutcomeofureteroscopic treatment for urinary lithiasis[J]. Journal of Urology, 2009,182(6):2768-2774.
[12]蔡万松,蒋祥新,闻立平.术前免留置双J管一期输尿管软镜治疗肾结石的临床研究[J].中国内镜杂志, 2016, 22(4):58-62.[12]CAI W S, JIANG X X, WEN L P. Clinical application of flexible ureteroscopy lithotripsy in treatment of renal calculi without preexistent ureteral stent[J]. China Journal of Endoscopy, 2016,22(4):58-62. Chinese
[13]DESSYN J F, BALSSA L, CHABANNES E, et al. Flexible ureterorenoscopy for renal and proximal ureteral stone in patients with previous ureteral stenting:impact on stone-free rate and morbidity[J]. Journal of Endourology, 2016, 30(10):1084-1088.
[14]LUMMA P P, SCHNEIDER P, STRAUSS A, et al. Impact of ureteral stenting prior to ureterorenoscopy on stone-free rates and complications[J]. World Journal of Urology, 2013, 31(4):855-859.
[15]ASSIMOS D, CRISCI A, CULKIN D, et al. Preoperative JJ stent placement in ureteric and renal stone treatment:results from the Clinical Research Office of Endourological Society(CROES)ureteroscopy(URS)global study[J]. BJU Int, 2016, 117(4):648-654.
[16]刘可,肖春雷,刘余庆,等.标准化技术输尿管软镜钬激光碎石术治疗输尿管近端及肾结石:单中心140例报告[J].中国微创外科杂志, 2015, 15(12):1065-1068.[16]LIU K, XIAO C L, LIU Y Q, et al. Management of intrarenal and proximalureteralstonesbystandardizedflexibleureteroscopic holmium laser lithotripsy:a single center experience from 140cases[J]. Chinese Journal of Minimally Invasive Surgery, 2015,15(12):1065-1068. Chinese