改良环套式拔管法与传统钳夹式拔管法在双J管拔除应用中的对比研究

发布时间：2018-04-02 00:37

本文选题：改良环套式拔管法　切入点：传统钳夹式拔管法　出处：《河北医科大学》2014年硕士论文

【摘要】：目的：随着泌尿外科腔内技术和理念的普及与发展，越来越多的腔内用器械和耗材应用于临床，双J管就是其中一种。因为现在临床中最常用的双J管不能长时间在体内留置，所以到一定时间后，就需要更换或者拔除。目前拔除双J管最主要的方法是经膀胱镜活检钳钳夹式拔除。通过临床观察及随访发现，应用活检钳钳夹拔管对患者的膀胱及尿道粘膜损伤较大，操作后血尿、尿痛等症状多有发生，为解决这一问题，我科结合临床拔管操作的切身体会，自主研发了改良环套式取管器。本次研究旨在于通过对比改良环套式取管器与传统活检钳在经膀胱镜下拔除双J管的相关指标，探讨选择拔除体内留置双J管更加合理的方法。方法：回顾性研究2013年9月至2014年1月期间，120例前来我院拟行拔管的患者，均在同一位有资质的医生操作下，行经膀胱镜双J管拔除术。研究前制定排除标准为：⑴患者年龄小于18周岁或大于65周岁，或年龄大于18岁小于65周岁，但存在感觉、认知、交流障碍；⑵患者近期有确切的抗凝药物、止痛药物应用史；⑶患者合并其他可能导致血尿、膀胱痉挛或伴有下尿路刺激症状的疾病，如良性前列腺增生（腺体大小为II°及以上）、前列腺癌、泌尿系感染、膀胱过度活动症(Overactive Bladder，OAB)等；⑷操作前复查腹部KUB平片或泌尿系B超，报告称未见双J管或显示双J管位置上移，末端未显露于膀胱内或双J管管周附着较多结石，预估直接拔管会造成严重损伤的患者；⑸膀胱容量过小，在60ml以下的患者；⑹处于经期的女性患者；⑺因各种原因导致的骨关节畸形或肌肉病变而无法采取截石位的患者。将满足研究条件的就诊患者随机分为实验组（即应用自制改良环套式取管器拔管组）与对照组（即应用传统活检钳拔管组）。收集两组研究对象的年龄、性别、置管病因、双J管位置等相关资料，研究过程中选取拔管操作时间、拔管过程疼痛程度[采用视觉模拟评分（visual analog scale，VAS)系统评估]、拔管操作后首次排尿是否为肉眼血尿、拔管后恢复正常排尿所需时间及随访得到的拔管后第1、2、3天晨尿尿常规化验结果等相关资料作为观察指标。采用SPSS16.0软件对收集到的资料进行统计学处理及分析。结果：1实验组与对照组在性别、年龄、置管位置方面的差异不显著，（P0.05）,因此可以排除性别、年龄、置管位置不同对实验观察指标的影响。 2实验组拔管操作时间平均为59.57±2.564s，对照组拔管操作时间平均为67.13±3.815s，两者比较差异无统计学意义（P0.05）。 3通过对实验组与对照组VSA测定值的比较，两组差异有统计学意义（P0.05），依据Mean Rank实验组=55.25，Mean Rank对照组=65.75，可以得出实验组受试对象疼痛程度低于对照组。 4实验组与对照组拔管操作后首次排尿为肉眼血尿患者构成比，差异有统计学意义（P0.05），且实验组拔管操作后首次排尿为肉眼血尿的患者所占的比例低于对照组。 5实验组拔管后恢复到正常排尿的时间平均为41.88±1.445h，对照组拔管后恢复到正常排尿的时间平均为47.65±1.513h，两者差异有统计学意义（P0.05），，且实验组患者拔管后恢复正常排尿所需时间少于对照组。 6实验组与对照组拔管后患泌尿系感染人数的构成比之间的差异无统计学意义（P0.05）。结论： 1通过对两种拔管方法的对比研究，发现改良环套式拔管法能减轻患者在操作过程中经受的痛苦，降低出血风险，缩短拔管操作后恢复至正常排尿所需的时间。 2对于改良环套式拔管法能否缩短操作时间，能否降低患者拔管后泌尿系感染的风险，将来需进一步扩大样本量，并优化随访方案来进一步探讨。
[Abstract]:Objective : With the popularization and development of the technique and concept in urological surgery , more and more intraluminal devices and consumables were used in clinic , and the double J tube was one of them .

Methods : From September 2013 to January 2014 , 120 patients who came to our hospital were removed by cystoscope double J tube . The criteria of exclusion were as follows : ( 1 ) the age of the patients is less than 18 years old or more than 65 years old , or the age is more than 18 years old , but there is feeling , cognition and communication disorder ;
( 2 ) the patient has definite anti - coagulation medicine and analgesic medicine application history in the near term ;
( 3 ) Patients with other diseases which may lead to hematuria , cystospasm or symptoms of lower urinary tract irritation , such as benign prostatic hyperplasia ( size II and above ) , prostate cancer , urinary tract infection , overactive prostate ( OAB ) , etc . ;
( 4 ) Review abdominal KUB plain film or urinary system B ultrasound before operation , report that no double J tube or double J tube position is removed , and the distal end is not exposed to the bladder or double J tube circumference to attach more calculus , and it is estimated that the direct extraction tube can cause serious injury ;
( 5 ) The bladder capacity is too small to be below 60ml ;
( 6 ) Female patients in menstrual period ;
( 7 ) Patients with osteoarticular deformity or muscle disease due to various reasons cannot be taken to take the stones .

Patients who met the conditions of study were randomly divided into two groups : experimental group ( i.e . , self - made modified ring - sleeve type tube taking - out group ) and control group ( i.e . , traditional biopsy forceps extraction group ) . The data collected were analyzed statistically by SPSS 16.0 software .

Results : There was no significant difference in sex , age and location between experimental group and control group ( P0.05 ) .

In the experimental group , the operation time was 59.57 卤 2.564s , the operation time of the control group was 67.13 卤 3.85 s , the difference was not statistically significant ( P0.05 ) .

3 Through comparison between the experimental group and the control group , the difference of the two groups was statistically significant ( P0.05 ) . According to the Mean Rank test group = 55.25 , Mean Rank Control = 65.75 , it was concluded that the degree of pain in the experimental group was lower than that of the control group .

There was significant difference between the experimental group and the control group ( P0.05 ) , and the proportion of patients with gross hematuria was lower than that of the control group .

In the experimental group , the average time of recovery to normal urination was 41.88 卤 1.445 h , the average time of recovery from the control group to normal urination was 47.65 卤 1.513h , the difference was statistically significant ( P0.05 ) .

There was no significant difference between experimental group and control group ( P0.05 ) .

Conclusion :

1 Through the comparative study of the two methods of extraction , it is found that the improved ring - sleeve tube - pulling method can reduce the pain experienced by the patient during operation , reduce the risk of bleeding , shorten the time required to restore normal urination after the extraction operation .

2 To improve the operation time and reduce the risk of urinary tract infection after the withdrawal of the patient , the sample size should be further expanded in the future , and the follow - up scheme is optimized for further discussion .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

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