微创经皮肾镜下碎石取石术后输尿管双J管留置时间和拔管方

经皮肾镜下碎石取石术后双J管留置时间和拔管方法的探讨

周厚勇邓建平张恒王永权李龙坤

（第三军医大学第一附属医院全军泌尿外科研究所，重庆，400038）

［摘要］目的探讨经皮肾镜下碎石取石术（PCNL）后双J管的最佳留置时间和拔管方法。方法94例行MPCNL治疗的上尿路结石患者完全随机分为3组，长期留苣组（n二28）,术后留置输尿管双J管4-6周，经膀胱镜下拔管；短期留垃组（n二28）,术后留宜输尿管双J管8-12天，经膀胱镜下拔管；短期留置改良组（n二28）,术后留巻输尿管双J管8-12天，经肾穿刺通道用改良方法拔管。三组患者于拔管后和岀院后分别填写问卷调查表，手术1月后复查肾功能和利尿肾图。结果患者在出院后发生肉眼血尿、腰胀、膀胱刺激征、泌尿系感染、发热、双J管移位、尿液反流等症状的发生率，长期留置组与短期留苣改良组、长期留置组与短期留巻组间均存在显著差异（P〈0.05）,短期留苣组与短期留置改良组间无明显差异（P>0. 05）。患者在拔管后发生尿道疼痛、肉眼血尿、尿道损伤、膀胱刺激征、泌尿系感染、发热等症状的发生率，短期留置改良组与长期留置组、短期留置改良组与短期留置组间均存在显著差异（P〈0.05）,长期留置组与短期留置组间无明显差异（P>0. 05） o手术1月后复查肾功能、利尿肾图，三组间差异均无统让学意义（P>0. 05）。结论经皮肾镜下碎石术后8-12 天采用改良方法拔管，可避免因带管岀院及置管时间过长所引起的并发症，减少患者的费用和痛苦，值得推广使用。

［关键词］经皮肾碎石取石；双J管；留置时间；拔管方法

Investigation on the different time and remove methods for double-pigtail stent after MPCNL

ZHOU HOU-yong. DENG JIAN-ping, ZHANG Heng. WANG YONG-quan. LI LONG-kun

（Urological institution of PLA, first affiliated hospital to third military colledge, Chongqing, 400038）

［Abstract］Objective To investigate the effect of different remain time and remove techniques for double-pigtail stent after the minimally invasive percutaneous nephrolithotomy （PCNL）. Method 94 paitients with upper urinary tract lithiasis were randomized into three groups: long-time group with 28 cases （double-pigtail stent for 4 to 6 weeks and removed with traditional technique under cystoscope）; short-time group with 28 cases （double-pigtail stent for 8 to 12 days and removed with traditional technique under cystoscope）; improved short-time group （double-pigtail stent for 8 to 12 days and removed with improved technique）. All of the three

groups needed to fulfill the answer sheet of complication and recheck the renal function and the diuresis renogram 1 month later after the operation・Results The incidence rate of the complications including gross hematuria, lumbus gas pains, irritarive symptoms of bladder, urinary infection, febrile, double-pigtail stent migration, vesicoureteric reflux were evaluated・ There is statistically different between the long-time and the improved short-time groups（P<0.05 ）, the long-time and the short-time groups （P<0.05） , but not the improved short-time and the short-time groups （P>0.05）. There was almost no significanct differences in the complications among the three groups 1 month later after the operation・Conclusion No effect occurred when remove the double-pigtail stent shorter after the MPCNL・ The improved technique should be recommended with its easy learning and performing, high achievement ratio, low cost price and no more complications.

[Key words] percutaneous nephrolithotomy； double-pigtail stent； remain time； remove method

经皮肾镜下碎石取石术（PCNL）已经成为全球范国治疗上尿路结石的主要术式之一，术后于输尿管内常规留置输尿管支架管，起到引流和支架作用，然而，双J管留管时间长短仍未有统一标准：同时，经尿道膀胱镜下的拔管方法可能存在的一左的痛苦和并发症，因此，对于双J管的留置时间和拔管方法进行研究和改良，将可能对临床带来新的启示。我们观察了不同的双J管留置时间，并改良拔管方法，效果明显，现报告如下。

1对象与方法

1.1 一般资料此临床研究资料，取自2010年8月至2011年4月因上尿路结石接受PCNL 治疗的患者，共计94例，其中男50例，女44例，年龄5-70岁，平均39. 6岁。其中肾结石并输尿管上段结石29例，单纯性肾结石53例，单纯性输尿管上段结石12例。其中残留结石7例，行二期淸石。术后常规于输尿管内留置输尿管双J管。

1.2方法对94例行PCNL治疗的上尿路结石患者完全随机分为3组，长期留置组

（n二28）,术后留置输尿管双J管4-6周，经尿道膀胱镜下拔管；短期留置组（n二28）,术后留置输尿管双J管8-12天，经尿道膀胱镜下拔管；短期留置改良组（n二28）,术后留置输尿管双J管8-12天，经肾穿刺通道用改良方法拔管。改良的置管和拔管方法：将双J管尾部与肾造痿管头端以四号丝线缝合固左，然后将双J管经肾造痿通道顺行垃入输尿管，以利拔管时利用造痿管的外带作用一并拔除内置之双J管。三组患者于拔管后和出院后分别填写相关并发症的问卷调査表，手术1月后复，査肾功能和利尿肾图。

1.3观察项目观察想者出院1月的相关症状及拔管后1周的相关症状。观察手术1月后患者的肾功能和利尿肾图结果。

1.4统计学方法采用SPSS17. 0软件进行分析，组间比较采用卡方检验，以P<0. 05