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

发布时间：2018-07-07 18:08

  本文选题：肾结石 + 输尿管软镜　； 参考：《广州医科大学》2014年硕士论文

【摘要】：研究目的 对比分析术前是否留置双J管对行经尿道输尿管软镜碎石取石术患者的疗效，安全性的影响。 研究方法 前瞻性对2013年11月至2014年3月60例行经尿道输尿管软镜碎石取石术的结石患者进行随机分组对照试验。每组30例，一组做好术前准备后直接行经尿道输尿管软镜碎石取石术（A组），另一组于入院当日局麻下予留置输尿管双J管1周后行经尿道输尿管软镜碎石取石术（B组），放置输尿管软镜通道鞘困难者予扩张输尿管，仍不成功者则改行经皮肾镜取石术或体外碎石术。对两组患者需要扩张输尿管所占比例，手术时间，住院时间，住院费用，术中术后并发症，术后1-2天及1个月后结石清除率等数据进行统计分析比较。 研究结果 本课题60例患者均成功I期行经尿道输尿管软镜碎石取石术，两组患者术中均未出现输尿管撕裂、断裂、穿孔、黏膜脱套及大出血等并发症。A组需要扩张输尿管的有6例，3例先予以输尿管筋膜扩张器扩张，不能扩张至F14，遂用输尿管球囊扩张器扩张输尿管至21F，余下3例均应用输尿管筋膜扩张器扩张至14F，B组有1例予以输尿管筋膜扩张器扩张至14F。两组一次性放置软镜通道鞘成功率分别为24/30(80%)、29/30(96.67%),两组输尿管一次性放置软镜通道鞘成功率差异比较无统计学意义。A组手术时间分别为78.3740.35min，B组分两次手术，局麻下逆行插管手术时间平均为13.776.88min，Ⅱ期平均手术时间为8032.85min；总手术时间平均为93.7736.03min。两组手术时间差异比较无明显统计学意义。全部病例术后均常规留置F6或F8双J管1条。A、B两组术后1-2天结石清除率分别为18/30（60%）、17/30（56.67%），两组患者术后无一例出现体温＞38.5℃，无脓毒血症的出现，全部病例术后均未出现因大出血需要输血者。住院治疗费用分别为19675.982880.03元、21060.566068.02元，差异无统计学意义。住院时间分别为6.71.74天、11.73.72天，差异比较有统计学意义，可明显缩短患者住院时间。术后1个月结石清除率两组分别为29/30(96.67%)、28/30(93.33%)，术后1个月结石清除率差异比较无统计学意义，A组中有一例患者术后1个月出现输尿管石街，再次入院行输尿管镜取石术。 结论 经尿道输尿管软镜碎石取石术前可不用常规预先留置输尿管双J管1-2周，手术安全有效，但需具备输尿管扩张器械（筋膜扩张器及球囊扩张器）等条件及技术。
[Abstract]:Objective to compare the effect and safety of double J tube before operation on patients undergoing transurethral soft ureteroscopy lithotripsy. Methods A prospective randomized controlled trial was conducted on 60 patients undergoing transurethral soft ureteroscopic lithotripsy from November 2013 to March 2014. 30 cases in each group, One group received direct transurethral soft ureteroscopy lithotripsy after preoperative preparation (group A), the other group received ureteral double J tube lithotripsy under local anesthesia on the day of admission (group B), and the other group underwent transurethral ureteral lithotripsy (group B) after 1 week of indwelling ureteral double J tube (group B). The ureter was dilated by dilatation of ureteral soft tunnel sheath. Those who still failed were treated with percutaneous nephrolithotomy or extracorporeal lithotripsy. The ratio of ureteral dilation, operation time, hospitalization cost, postoperative complications, stone clearance rate of 1-2 days and 1 month after operation were analyzed and compared between the two groups. Results all 60 patients were successfully treated with transurethral ureteral lithotripsy. No ureteral laceration, rupture or perforation were found in both groups. In group A, 6 cases needed to dilate ureter and 3 cases were treated with ureteral fascia dilator dilatation. The ureteral fascia dilator was used to dilate the ureter to 21F with ureteral balloon dilator. One case in group B was dilated to 14F with ureteral fascia dilator. The successful rate of soft mirror sheath placement in two groups was 24 / 30 (80%) 29 / 30 (96.67%) respectively. There was no significant difference between two groups. The operative time of group A was 78.3740.35 min. The average time of retrograde intubation under local anesthesia was 13.776.88 min, that of stage 鈪，

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