摘要
目的 分析上尿路手术术后输尿管支架附壁结石的临床特征与处理方式,剖析附壁结石形成的可能原因,探讨防范和处理对策.方法 选取2022年1月至2023年12月浙江省人民医院收治的23例上尿路手术术后输尿管支架附壁结石患者作为研究组,并随机纳入同期入院的42例上尿路手术术后无输尿管支架附壁结石患者作为对照组.统计并比较两组患者的年龄、性别、体质量指数(body mass index,BMI)、尿常规、尿培养、血肌酐、依据肌酐评估的肾小球滤过率(glomerular filtration rate,GFR)、有无代谢综合征、支架管留置时间、既往手术方式等基本情况.根据患者结石情况,选择不同手术方式进行碎石并更换输尿管支架管.结果 两组年龄、性别、BMI、血肌酐、GFR、有无代谢综合征、是否双侧置管、既往手术方式、是否存在术前尿路感染比较,差异均无统计学意义(P＞0.05).两组输尿管支架留置时间比较,差异有统计学意义(P＜0.05).附壁结石大小与支架管留置时间呈正相关(回归系数为0.29,95％CI 0.19～0.39,P＜0.001).附壁结石最大径平均(3.2± 0.6)cm,术后平均住院时间为5.0(3.0,6.0)d,术后平均留置时间为1.0(1.0,2.0)个月.8例接受体外冲击波碎石术(extracorporeal shock-wave lithotripsy,ESWL)后顺利拔管,9例接受逆行输尿管镜碎石术后成功拔管,6例接受顺行经皮肾镜联合逆行输尿管镜下碎石术后拔除滞留支架管.所有患者术后重新更换支架管并在0.5～3.0个月后门诊拔除.9例附壁结石成分为草酸钙患者术后带管期间口服枸橼酸钾缓释片,均未出现附壁结石复发导致再次拔管困难.术后随访3～12个月,无输尿管狭窄、肾积水、肾结石复发病例.结论 附壁结石成分构成与上尿路结石大体相同.输尿管支架管附壁结石的发生及其直径大小,与支架管留置时间呈正相关.大多数附壁结石成分质地疏松,可通过相应手术方式进行处理.长期留置输尿管支架管患者,参照常规上尿路结石的定期随访管理较为重要.
Abstract
Objective To analyze the clinical characteristics and management approaches of encrusted stones associated with ureteral stents following the treatment of upper urinary tract,investigate potential causes of encrusted stone formation,and to explore clinical strategies for prevention and management.Methods The clinical data of 23 patients admitted to Zhejiang Provincial People's Hospital from January 2022 to December 2023 with encrusted stones associated with ureteral stents after upper urinary tract surgery were retrospectively analyzed.Forty two patients admitted during the same period without encrusted stones were randomly included in the study as the control group.Basic information such as age,gender,body mass index(BMI),urinalysis,urine culture,blood creatinine,estimated glomerular filtration rate(GFR),presence of metabolic syndrome,duration of stent placement,and previous surgical methods were collected for both groups of patients.Based on the stone conditions,different surgical approaches were selected for stone fragmentation and replacement of the ureteral stents.Results There were no significant differences in age,gender,BMI,blood creatinine,GFR,presence of metabolic syndrome,bilateral stent placement,previous surgical methods,or preoperative urinary tract infection between the two groups(P＞0.05).There was a significant difference in the preoperative duration of stent placement between the two groups(P＜0.05),and the size of the encrusted stone was positively correlated with the duration of stent placement(regression coefficient:0.29,95％CI 0.19-0.39,P＜0.001).The mean maximum diameter of the encrusted stone was(3.2±0.6)cm,the mean postoperative hospital stay was 5.0(3.0,6.0)days,and the mean postoperative duration of stent placement was 1.0(1.0,2.0)months.Eight patients underwent extracorporeal shock-wave lithotripsy(ESWL)and successfully had the stent removed.Nine patients underwent retrograde ureteroscopic lithotripsy and had the stent removed successfully,and six patients underwent antegrade percutaneous nephrolithotomy combined with retrograde ureteroscopic lithotripsy to remove the retained stents.All cases underwent stent replacement after surgery,and the stent were removed in the outpatient department 0.5-3.0 months later.Nine patients with calcium oxalate encrusted stones were given oral slow-release potassium citrate tablets during the postoperative period with stent placed.None of the cases experienced recurrence of encrusted stones leading to difficult stent removal.Follow-up for 3-12 months postoperatively,there was no cases of ureteral stricture,hydronephrosis,or renal stone recurrence.Conclusions The composition of encrusted stones was generally similar to that of upper urinary tract stones.The occurrence and size of encrusted stones associated with ureteral stents were positively correlated with the duration of stent placement.The majority of encrusted stones had a loose texture and could be treated by appropriate surgical methods.For patients with long-term placement of ureteral stents,it is important to follow up as routine management of upper urinary tract stones.
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万方数据