单J管与双J管比较在全膀胱手术中应用的优势研究

发布时间：2018-02-23 23:22

本文关键词： 膀胱肿瘤膀胱癌根治术输尿管支架尿漏肾盂肾炎　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过比较单J管和双J管作为输尿管支架在膀胱肿瘤根治性切除术中的安全性及其优势,为临床输尿管支架的选择提供参考。方法:回顾性分析青岛大学附属青岛市立医院泌尿外科自2013年至2016年98例全膀胱手术患者的临床资料,并按尿流改道的方式把行全膀胱手术的患者分成输尿管皮肤造口术组(A组)、回肠膀胱术组(B组)及原位膀胱术(C组)三组。其中男性患者79例,女性患者19例。平均年龄(63.9±10.5)(32~82)岁。分别比较应用双J管跟单J管在三组患者中尿漏发生率、尿路感染率、急性肾盂肾炎发生率(AP)、输尿管支架发生脱落、回缩、移位的发生率以及住院天数的差异。结果:输尿管皮肤造口术组、回肠膀胱术组、原位新膀胱组三组患者在年龄、性别、BMI、术前血红蛋白、白蛋白值、相关的合并症上没有显著差异。在输尿管皮肤造口术组中,单J管组与双J管组均未发生尿漏,尿路感染率分别为28.6%和26.7%。单J管组有1例发生肾盂肾炎,双J管组有2例发生肾盂肾炎。差异无统计学意义。双J管组有1例患者于术后2个月发生双J管回缩。住院天数分别为19天(14 29d)和21天(9 39d)。在回肠膀胱术组中,单J管组有3例发生尿漏,双J管组有2例发生尿漏,尿路感染率分别为36.8%和40%。两组患者均未发生肾盂肾炎,亦无支架回缩、移位。住院天数分别为23天(11 42d)和23天(15 47d)。在原位新膀胱术组中,单J管组无尿瘘发生,双J管组有4例发生尿漏,尿路感染率分别为(25%)和(62.5%)。两者差异有统计学意义(P0.05)。单J管组未出现急性肾盂肾炎,双J管组有4例发生肾盂肾炎(25%),差异有统计学意义(P0.05)。两组未发生输尿管支架移位。住院天数分别为20.5天(16 49d)和23.5天(16 65d)。在输尿管皮肤造口术组、原位新膀胱术组中,单J管组的中位住院时间均明显短于双J管组。输尿管皮肤造口术组分别为19天(14 29d)和21天(9 39d)(P=0.001)。原位新膀胱术组分别为20.5天(16 49d)和23.5天(16 65d)(P=0.001)。在回肠代膀胱组中单J管组与双J管组中位住院时间相仿,为23天(范围分别11 42d,15-47d)。结论:在全膀胱三种术式中,输尿管腹壁造口术及回肠膀胱术式中应用单J与双J管相比无明显优势,在原位新膀胱术式中,与双J管相比单J管可降低尿漏率及尿路感染率,缩短住院时间。值得在临床中优先选择。
[Abstract]:Objective: to compare the safety and advantages of single J tube and double J tube as ureteral stent in radical resection of bladder tumor. Methods: the clinical data of 98 patients undergoing urinary surgery in Qingdao Municipal Hospital affiliated to Qingdao University from 2013 to 2016 were retrospectively analyzed. The patients undergoing total bladder surgery were divided into three groups: ureteral dermatostomy group (group A), ileal cystectomy group (group B) and in situ cystectomy group (group C). The average age of 19 female patients was 63.9 卤10.5 years. The incidence of urinary leakage, urinary tract infection, acute pyelonephritis, ureteral stents and ureteral stents were compared in the three groups. Results: age, sex, hemoglobin and albumin were measured in three groups: ureteral dermatostomy group, ileal cystectomy group, orthotopic neobladder group. In the ureteral dermatostomy group, there were no urinary leakage in single J tube group and double J tube group, the urinary tract infection rate was 28.6% and 26.7.The single J tube group had one case of pyelonephritis. There were 2 cases of pyelonephritis in the double J tube group with no statistical significance. In the double J tube group, one patient had double J tube retraction 2 months after operation. The days of hospitalization were 19 days (14 days) and 21 days (9 days) and 39 days respectively. In the ileal bladder operation group, there was no significant difference between the two groups. Urinary leakage occurred in 3 cases in the single J tube group and in 2 cases in the double J tube group. The urinary tract infection rate was 36.8% and 40 respectively. No pyelonephritis and no stent retraction were found in both groups. The days of hospitalization were 23 days, 11 days, 42 days, and 23 days, 15 days and 47 days respectively. In the group of new bladder surgery in situ, there was no urine fistula in the single J tube group, 4 cases in the double J tube group, and 4 cases in the double J tube group. The urinary tract infection rate was 25% and 62.5% respectively. There was a significant difference between the two groups (P 0.05). There was no acute pyelonephritis in the single J tube group, and there was no acute pyelonephritis in the single J tube group. In the double J tube group, there were 4 cases of pyelonephritis and 25 cases of pyelonephritis, the difference was statistically significant (P 0.05). No transposition of ureteral stents occurred in the two groups. The days of hospitalization were 20.5 days (16 days) and 23.5 days (16 minutes 65 days). In the ureteral dermatostomy group, there was no change of ureteral stent. The median hospitalization time of single J tube group was significantly shorter than that of double J tube group, and that of ureteral dermatostomy group was 19 days (14 / 29 days) and 21 days (9 ~ 39days), and that of in situ neocystectomy group was 20.5 days (16 / 49d) and 23.5 / day / 1665days (P0.001) respectively. The median length of stay in the J tube group was similar to that in the double J tube group. Conclusion: the ureteral abdominal wall ostomy and ileal bladder operation have no obvious advantage over double J tube in the three types of total bladder operation, and in the new bladder operation in situ, there is no obvious advantage between single J and double J tube, and there is no significant difference between the three types of ureteral abdominal wall ostomy and ileal bladder operation. Compared with double J tube, single J tube can reduce urinary leakage rate and urinary tract infection rate and shorten hospitalization time.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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