王光智 陈国强 吴智煌

[摘要] 目的 探讨结石伴息肉导致输尿管狭窄患者行同侧两根双J管引流的临床价值。方法 方便选取该院于2013年1月—2019年12月接收的输尿管结石伴息肉导致输尿管狭窄患者120例，通过抽签法形式，以1∶1原则分为观察组和对照组。观察组腔内碎石术后，同侧输尿管内留置两根双J管，对照组腔内碎石术后留置一根双J管。记录观察组和对照组手术用时、肌酐降低情况、肾积水减少情况、结石清除率以及并发症发生率。 结果 观察组和对照组手术后血肌酐差值以及结石清除率对比，组间差异无统计学意义（P>0.05）;观察组肾积水减少（23.50±6.98）mm高于对照组（20.09±7.27）mm，组间对比差异有统计学意义（t=2.621，P<0.05）;观察组和对照组术后并发症发生率对比，差异无统计学意义（P>0.05）。结论 对于输尿管结石伴息肉导致输尿管狭窄患者，通过采用输尿管腔内碎石术后，同侧留置两根双J管短期引流效果更佳。

[关键词] 输尿管结石;息肉;输尿管狭窄;双J管引流

[中图分类号] R699          [文献标识码] A          [文章编号] 1674-0742（2020）08（c）-0061-03

[Abstract] Objective To investigate the clinical value of two double J tubes on the same side of patients with ureteral stenosis caused by calculi and polyps. Methods A total of 120 patients with ureteral calculi and polyps leading to ureteral stenosis received in the hospital January 2013 to December 2019 were conveniently selected. They were divided into observation group and control group based on the 1：1 principle by drawing lots. After intracavitary lithotripsy in the observation group， two double J tubes were placed in the ipsilateral ureter， and one double J tube was placed in the control group after intracavitary lithotripsy. The operation time， creatinine reduction， hydronephrosis reduction， stone removal rate and complication rate of observation group and control group were recorded. Results The difference in serum creatinine and stone clearance rate between the observation group and the control group after surgery was not statistically significant （P>0.05）; the observation groups hydronephrosis decreased by（23.50±6.98）mm higher than the control group（20.09±7.27）mm， the comparison between groups was statistically significant （t=2.621，P<0.05）; the observation group and the control group had no statistically significant difference in the incidence of postoperative complications （P>0.05）. Conclusion For patients with ureteral stenosis caused by ureteral calculi and polyps， the short-term drainage effect of two double J tubes on the same side is better after the use of ureteral lithotripsy.

[Key words] Ureteral stones; Polyps; Ureteral stenosis; Double J tube drainage

臨床中输尿管结石嵌顿如果>60 d，则输尿管狭窄率将提升到20.00%以上。且结石伴息肉导致的输尿管狭窄在临床中十分多见[1]。在微创设备的不断创新和发展中，常规开放手术形式已经被腔内治疗形式代替。输尿管狭窄腔内的治疗形式通常包含输尿管硬镜扩张，球囊扩张处理以及冷刀内切开或者钬激光内切开处理，为了进一步让结石排出，同时对尿液引流，预防输尿管狭窄，手术后均基础放置双J管[2]。一侧双J管引流无法改善输尿管梗阻反应，但是同侧输尿管腔内留置两根双J管就能达到较为显著的引流价值。因此文……