CAJ | 학술논문

目的：研究输尿管软镜联合钬激光治疗碎石术后双J管留置时间与并发症关系。方法将该院从2011-2013年收入的90例肾结石患者（结石＜2．0 cm）随机分成2组均行输尿管软镜联合钬激光治疗碎石术。术后观察分析2组留置双J管时间（留置2周和4周）与并发症发生情况的关系。所有患者记录在其拔除双J管前并发症的发生；分别于拔除双J管后1周和1月复查尿常规；拔管后1个月复查彩超、腹部平片检查残石率，并行99 Tc m-DTPA核素肾图检查，记录患侧肾脏肾小球滤过率（GFR）。结果2组均出现不同程度的并发症，拔除双J管前2组患者出现下尿路刺激症状（LUTS）分别为33例（70．2％）和40例（93．0％），腰腹痛分别为13例（27．7％）和21例（48．8％），肉眼血尿分别为36例（76．6％）和42例（97．7％），双J管上移分别为0例（0．0％）和2例（4．7％），拔管管壁钙盐沉积或拔管困难分别为4例（8．5％）和11例（25．6％）。并发症的发生率随留置时间延长均明显升高，差异有统计学意义（P＜0．05）。拔除双J管1个月后复查彩超及腹部平片，提示无泌尿系结石残留，或残留结石直径＜3 mm，2组的结石残石率无统计学意义。2组患者拔管后1周及1个月复查尿常规大致正常。2组比较，患侧肾脏的肾小球滤过率（GFR）无统计学意义（P＞0．05）。结论输尿管软镜联合钬激光碎石术后留置双J管时间2周较安全有效，减少并发症发生的同时不影响残石清除及肾功能的恢复。
목적：연구수뇨관연경연합화격광치료쇄석술후쌍J관류치시간여병발증관계。방법장해원종2011-2013년수입적90례신결석환자（결석＜2．0 cm）수궤분성2조균행수뇨관연경연합화격광치료쇄석술。술후관찰분석2조류치쌍J관시간（류치2주화4주）여병발증발생정황적관계。소유환자기록재기발제쌍J관전병발증적발생；분별우발제쌍J관후1주화1월복사뇨상규；발관후1개월복사채초、복부평편검사잔석솔，병행99 Tc m-DTPA핵소신도검사，기록환측신장신소구려과솔（GFR）。결과2조균출현불동정도적병발증，발제쌍J관전2조환자출현하뇨로자격증상（LUTS）분별위33례（70．2％）화40례（93．0％），요복통분별위13례（27．7％）화21례（48．8％），육안혈뇨분별위36례（76．6％）화42례（97．7％），쌍J관상이분별위0례（0．0％）화2례（4．7％），발관관벽개염침적혹발관곤난분별위4례（8．5％）화11례（25．6％）。병발증적발생솔수류치시간연장균명현승고，차이유통계학의의（P＜0．05）。발제쌍J관1개월후복사채초급복부평편，제시무비뇨계결석잔류，혹잔류결석직경＜3 mm，2조적결석잔석솔무통계학의의。2조환자발관후1주급1개월복사뇨상규대치정상。2조비교，환측신장적신소구려과솔（GFR）무통계학의의（P＞0．05）。결론수뇨관연경연합화격광쇄석술후류치쌍J관시간2주교안전유효，감소병발증발생적동시불영향잔석청제급신공능적회복。
Objective To evaluate the relationship of complication and indwelling time of Double-J ureteral stents after flexible uret-eroscopy (FURS)and holmium laser lithotripsy.Methods Ninety patients with renal calculi (<2.0 cm)were randomized into two groups who were admitted to General Hospital of Shenyang Military Command from 2011 to 2013,group Ⅰ(stents indwelling 2 weeks) and groupⅡ(stents indwelling 4 weeks).Complications of the two groups were compared.The symptoms of these two groups during and after ureteral stents indwelled were observed and compared.A follow-up by urinalysis was done 1 week and 1 month after removal of Double-J.A follow-up by Color Dupplex Sonography and KUB was done 1 month after removal of Double-J to evaluate the rate of residu-al stone.And 99 Tcm-DTPA scintigraphy was done 1 month after removal of Double-J to record the affected kidney GFR.Results The two groups had complications more or less.In group Ⅰand group Ⅱ repectively,there were lower urinary tract symptom(LUTS)33 (70.2%)and 40(93.0%),flank pain 13(27.7%)and 21(48.8%),hemaurine 36(76.6%)and 42(97.7%),Double-J moving 0 and 2(4.7%),encrustation or dysextraction of Double-J 4(8.5%)and 11(25.6%).With the prolonged retention time,the incidence of the complications were significantly increased with statistical significance(P<0.05).The Color Dupplex Sonography and KUB were done 1 month after removal of Double-J,No residual stone or stone’s diameter<3 mm was found.In the two groups,the rate of residual stone was not statistically significant.Routine urinalysis which was taken 1 week and 1 month after removal of Double-J was not abnor-mal.GFR was not statistically significant between 2 groups(P>0.05).Conclusions After flexible ureteroscopy (FURS)and holmi-um laser lithotripsy,shortening postoperative indwelling time(2 weeks)of Double-J internal ureteral stents could be safe.This could de-crease the incidence of complications,which will not prevent the residual stone discharge and the recovery of renal function.