术前免留置双J管在输尿管软镜治疗肾输尿管上段结石中的临床应用研究

吴宇; 冯飞鸣; 徐卫强; 谷明利

doi:10.16766/j.cnki.issn.1674-4152.003910

术前免留置双J管在输尿管软镜治疗肾输尿管上段结石中的临床应用研究

doi: 10.16766/j.cnki.issn.1674-4152.003910

蚌埠医科大学第二附属医院泌尿外科，安徽蚌埠 233000

基金项目:

安徽省高等学校科学研究项目 2022AH051520

；蚌埠医学院自然科学类项目 2022byzd082

详细信息

通讯作者:
谷明利，E-mail：gumingli2006@126.com

中图分类号: R693.4 R699.4
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出版历程
- 收稿日期: 2024-03-15
- 网络出版日期: 2025-05-14

Clinical study on preoperative non-retention of double J-tube in the treatment of upper renal and ureteric calculi with flexible ureteroscope

Department of Urology, the Second Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨术前免留置双J管对输尿管软镜治疗肾输尿管上段结石的应用前景。方法回顾性分析2020年9月—2022年9月蚌埠医科大学第二附属医院泌尿外科输尿管软镜治疗的100例肾结石或输尿管上段结石患者的临床资料。按照术前是否留置双J管将患者分为2组，试验组50例术前免留置双J管，一期行输尿管软镜钬激光碎石术，对照组50例术前留置双J管，二期手术治疗。比较2组患者通道鞘一次性成功率、手术时间、术后住院时间、并发症发生率、住院费用及结石残留率等指标。结果试验组和对照组的通道鞘一次性成功率、手术时间、术后住院时间和结石残留率比较，差异均无统计学意义(P＞0.05)。2组术后C反应蛋白、降钙素原、血尿发生率、感染发生率、泌尿系损伤及总并发症发生率比较，差异均无统计学意义(P＞0.05)。试验组的住院费用[(1.419±0.148)万元]低于对照组[(1.677±0.161)万元]，差异有统计学意义(t=8.364，P<0.001)。结论术前免留置双J管对输尿管软镜治疗肾输尿管上段结石的手术成功率、手术时间、术后住院时间、并发症发生率及结石残留率等无明显影响，但可显著降低患者的住院费用，临床上值得推广。
- 输尿管软镜 /
- 肾输尿管上段结石 /
- 术前免留置双J管
Abstract: Objective To explore the application prospects of preoperative non-retention of double J-tube in the treatment of upper renal and ureteric calculi with flexible ureteroscope. Methods A retrospective analysis was conducted on the clinical data of 100 patients with renal calculi or upper ureteric calculi treated with flexible ureteroscope in the Urology Department of the Second Affiliated Hospital of Bengbu Medical University from September 2020 to September 2022. The patients were divided into two groups based on whether a double-J stent was indwelled preoperatively. In the experimental group, 50 patients underwent flexible ureteroscope holmium laser lithotripsy in the first stage without preoperative retention of double J-tube, while the control group of 50 patients received preoperative double-J tube placement and second-stage surgical treatment. The indicators such as one-time success rate of access sheath, operation time, postoperative hospital stay, complication rate, hospitalization costs, and stone residue rate were compared between the two groups of patients. Results There were no statistically significant differences between the two groups in terms of the one-time success rate of the access sheath, operation time, postoperative hospital stay, and residual stone rate (P>0.05). There were also no statistically significant differences between the two groups in postoperative C-reactive protein, procalcitonin, incidence of hematuria, infection, urinary system injury, and overall complication rates (P>0.05). The hospitalization cost of the experimental group was [(14 190±148) yuan], which was lower than that of the control group [(16 770±161) yuan], and the difference was statistically significant (t=8.364, P<0.001). Conclusion Preoperative non-retention of double J-tube has no significant impact on the surgical success rate, operation time, postoperative hospital stay, complication rate, and stone residue rate in the treatment of upper renal and ureteric calculi with flexible ureteroscope. However, it can significantly reduce the hospitalization costs for patients, and is worth promoting clinically.
- Flexible ureteroscopy /
- Upper renal and ureteric calculi /
- Preoperative non-retention of double J-tube

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表 1 2组肾结石或输尿管上段结石患者基线资料比较

Table 1. Comparison of baseline data between the two groups of patients with kidney stones or upper ureteral stones

组别	例数	年龄 (x±s，岁)	性别(例)		结石体积 [M(P₂₅, P₇₅), mm²]	BMI (x±s)
组别	例数	年龄 (x±s，岁)	男性	女性	结石体积 [M(P₂₅, P₇₅), mm²]	BMI (x±s)
试验组	50	45.96±18.25	32	18	715.50(405.00, 1 621.00)	23.12±3.05
对照组	50	46.36±18.60	30	20	565.00(355.75, 1 602.50)	23.13±3.30
统计量		0.110^a	0.170^b		-0.304^c	-0.012^a
P值		0.913	0.680		0.762	0.991
注：^a为t值，^b为x²值, ^c为Z值。

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表 2 2组肾结石或输尿管上段结石患者住院时间、手术时间、残石率及手术成功率比较

Table 2. Comparison of hospitalization time, operation time, residual stone rate, and surgical success rate between the two groups of patients with renal or upper ureteral calculi

组别	例数	术后住院时间 (x±s，d)	手术时间 (x±s，min)	住院费用 (x±s，万元)	结石残留 [例(%)]	手术成功 [例(%)]
试验组	50	2.54±0.54	64.80±16.21	1.419±0.148	10(20.0)	48(96.0)
对照组	50	2.70±0.46	61.14±15.58	1.677±0.161	16(32.0)	49(98.0)
统计量		1.586^a	1.151^a	8.364^a	1.871^b	0.344^b
P值		0.116	0.253	< 0.001	0.171	0.558
注：^a为t值，^b为x²值。

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表 3 2组肾结石或输尿管上段结石患者术后C反应蛋白、降钙素原及并发症发生率比较

Table 3. Comparison of postoperative C-reactive protein, procalcitonin, and incidence of complications in patients with renal or upper ureteral stones between the two groups

组别	例数	C反应蛋白 [M(P₂₅, P₇₅), mg/L]	降钙素原 [M(P₂₅, P₇₅), ng/mL]	血尿 [例(%)]	感染 [例(%)]	并发症发生 [例(%)]
试验组	50	5.85(2.60，8.02)	0.355(0.208，0.403)	5(10.0)	10(20.0)	15(30.0)
对照组	50	4.15(0.85，7.65)	0.255(0.195，0.450)	8(16.0)	8(16.0)	16(32.0)
统计量		-1.369^a	-0.587^a	0.796^b	0.271^b	0.047^b
P值		0.163	0.558	0.372	0.603	0.829
注：^a为Z值，^b为x²值。

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