Clinical value of indwelling anti-reflux ureteral stent after ureteroscopic lithotripsy
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摘要: 目的 比较输尿管镜碎石术后留置普通输尿管支架管(双J管)和防逆流双J管对手术时间的影响以及带管期间的相关症状，探讨防逆流双J管的应用价值。方法 回顾性分析2020年3月—2022年3月行输尿管镜钬激光碎石术后留置双J管的223例患者的临床资料。患者选择留置双J管类型，其中108例术后留置普通双J管(普通组)，115例术后留置防逆流双J管(防逆流组)，比较两组手术时间和带管期间双J管综合征(泌尿道感染、肉眼血尿、腰痛和下腹痛、膀胱过度活动症状、双J管移位和双J管附管结石)的发生情况。结果 两组手术时间、泌尿道感染、肉眼血尿、下腹痛、膀胱过度活动症状、双J管移位、双J管附管结石比较，均差异无统计学意义。防逆流组中度和重度腰痛症状低于普通组，差异有统计学意义(P < 0.05)。结论 输尿管镜碎石术后留置防逆流双J管比普通双J管腰痛症状轻，疼痛敏感患者可以选择应用。Abstract: Objective To compare the effects between indwelling conventional ureteral stent(double J stent) and anti-reflux double J tube after ureteroscopic lithotripsy on the operation time and related symptoms, then explore the clinical value of anti-reflux ureteral stent.Methods The clinical data of 223 patients with double J stent indwelling after ureteroscopic holmium laser lithotripsy from March 2020 to March 2022 were analyzed retrospectively. Patients selected the ureteral stent type. One hundred and eight patients with conventional double J stent indwelling were included into the conventional group, and 115 patients with anti-reflux double J stent indwelling were included into the anti-reflux group. The operation time and double J stent syndromes during the period of ureteral stenting(urinary tract infection, gross hematuria, pain in the waist and lower abdomen, overactive bladder symptoms, stent displacement and calculi attached to the stent) between the two groups were compared.Results There were no significant differences between the two groups in operation time, urinary tract infection, gross hematuria, pain in the lower abdomen, overactive bladder symptoms, stent displacement or calculi attached to the stent, while the symptoms of moderate and severe waist pain in the anti-reflux group were lower than those in the conventional group(P < 0.05).Conclusion The anti-reflux ureteral stent produces lighter symptoms of low back pain than conventional double J stent after ureteral lithotripsy, which can be used in pain sensitive patients.
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Key words:
- ureteral calculi /
- anti-reflux /
- ureteral stent /
- clinical value
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表 1 普通组与防逆流组基本资料比较
例(%)，X±S 项目 普通组(108例) 防逆流组(115例) t/χ2 P 性别 0.216 0.642 男 69(63.9) 70(60.9) 女 39(36.1) 45(39.1) 年龄/岁 59.8±11.4 60.7±10.5 0.606 0.544 结石侧别 0.572 0.449 左 59(54.6) 57(49.6) 右 49(45.4) 58(50.4) 肾盂分离/mm 22.6±6.3 21.9±6.4 0.813 0.418 双J管留置时间/d 14.7±0.9 14.9±1.1 0.831 0.409 
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表 2 普通组与防逆流组手术时间和双J管综合征比较
例(%)，X±S 项目 普通组(108例) 防逆流组(115例) t/χ2 P 手术时间/min 64.6±16.1 67.3±15.8 1.246 0.214 泌尿道感染a) 17(15.7) 16(13.9) 0.148 0.700 肉眼血尿 23(21.3) 25(21.7) 0.006 0.938 腰痛 22.715 < 0.001 无痛 47(43.5) 83(72.2) 18.811 < 0.001 轻度 31(28.7) 23(20.0) 2.299 0.129 中度 23(19.4) 8(4.3) 9.569 0.002 重度 7(6.5) 1(0.9) 5.071 0.024 下腹痛 0.043 0.979 无痛 55(50.9) 57(49.6) 0.041 0.840 轻度 44(40.7) 48(41.7) 0.023 0.879 中度 9(8.3) 10(8.7) 0.009 0.924 重度 0 0 OAB评分 0.122 0.941 无 59(54.6) 61(53.0) 0.056 0.813 轻度 38(35.2) 43(37.4) 0.117 0.732 中度 11(10.2) 11(9.6) 0.024 0.877 重度 0 0 双J管移位b) 2(1.9) 2(1.7) 0.004 0.950 附管结石c) 1(0.9) 2(1.7) 0.278 0.598 注：a)普通组2例、防逆流组1例出现尿源性脓毒症；b)普通组1例双J管上移、1例自行排出尿道，防逆流组1例双J管上端折叠、1例下移至膀胱内；c)普通组1例附管石痂位于双J管膀胱端，防逆流组1例附管石痂位于双J管膀胱端、1例附管结石位于防逆流瓣膜处。
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