经皮肾碎石取石术后输尿管双j管留置时间和拔管 - 第三军医大学学报.docVIP

经皮肾碎石取石术后输尿管双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( （400038 重庆，第三军医大学西南医院全军泌尿外科研究所） (作者：周厚勇(1977-)，男，兰州军区乌鲁木齐总医院医师，硕士研究生，主要从事泌尿系结石方面的研究，电话E-mail：zhou-hou-yong@ ( 通迅作者：李龙坤(023教授，主任医师，博士生导师。电话：(023E-mail：lilongk@hot [摘要] 目的 对经皮肾碎石取石术（percutaneous nephrolithotomy， PCNL）后患者输尿管双J管留置时间长短及拔管方法进行探讨。方法 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=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=28），术后留置输尿管双J管8～12 d，经尿道膀胱镜下拔管；短期留置改良组（n=28），术后留置输尿管双J管8～12 d，经肾穿刺通道用改良方法拔管。3组患者于拔管后和出院后分别填写问卷调查，手术1月后复查肾功能和利尿肾图。结果 患者出院后在肉眼血尿、腰胀、膀胱刺激征、泌尿系感染、发热、双J管移位、尿液反流等并发症的发生率上，长期留置组分别与短期留置改良组、短期留置组间存在显著差异（P0.05），短期留置组与短期留置改良组间无明显差异(P0.05)。患者拔管后在尿道疼痛、肉眼血尿、尿道损伤、膀胱刺激征、泌尿系感染、发热等并发症的发生率上，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（P0.05），长期留置组与短期留置组间无明显差异(P0.05)。手术1月后复查肾功能、利尿肾图，3组间差异无统计学意义。结论 经皮肾碎石取石术后8～12 d，有针对性采用改良方法拔管，可有效缩短双J管的留置时间，避免因带管出院及置管时间过长引起的并发症，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 [中图法分类号] [文献标志码] A Investigation on the different time and remove methods for double-pigtail stent after PCNL Zhou Houyong, Deng Jianping, Zhang Heng, Wang Yongquan, Li Longkun (Urological institution of PLA, first affiliated hospital to third military colledge, chongqing, 400038,China) [Abstract] Objective To investigate the effect of different remain time and remove techniques for double-pigtail stent after the 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 t