本文選題：改良環(huán)套式拔管法　切入點：傳統(tǒng)鉗夾式拔管法　出處：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：隨著泌尿外科腔內(nèi)技術(shù)和理念的普及與發(fā)展，越來越多的腔內(nèi)用器械和耗材應(yīng)用于臨床，雙J管就是其中一種。因為現(xiàn)在臨床中最常用的雙J管不能長時間在體內(nèi)留置，所以到一定時間后，就需要更換或者拔除。目前拔除雙J管最主要的方法是經(jīng)膀胱鏡活檢鉗鉗夾式拔除。通過臨床觀察及隨訪發(fā)現(xiàn)，應(yīng)用活檢鉗鉗夾拔管對患者的膀胱及尿道粘膜損傷較大，操作后血尿、尿痛等癥狀多有發(fā)生，為解決這一問題，我科結(jié)合臨床拔管操作的切身體會，自主研發(fā)了改良環(huán)套式取管器。本次研究旨在于通過對比改良環(huán)套式取管器與傳統(tǒng)活檢鉗在經(jīng)膀胱鏡下拔除雙J管的相關(guān)指標(biāo)，探討選擇拔除體內(nèi)留置雙J管更加合理的方法。 方法：回顧性研究2013年9月至2014年1月期間，120例前來我院擬行拔管的患者，均在同一位有資質(zhì)的醫(yī)生操作下，行經(jīng)膀胱鏡雙J管拔除術(shù)。研究前制定排除標(biāo)準(zhǔn)為：⑴患者年齡小于18周歲或大于65周歲，或年齡大于18歲小于65周歲，但存在感覺、認知、交流障礙；⑵患者近期有確切的抗凝藥物、止痛藥物應(yīng)用史；⑶患者合并其他可能導(dǎo)致血尿、膀胱痙攣或伴有下尿路刺激癥狀的疾病，如良性前列腺增生（腺體大小為II°及以上）、前列腺癌、泌尿系感染、膀胱過度活動癥(Overactive Bladder，OAB)等；⑷操作前復(fù)查腹部KUB平片或泌尿系B超，報告稱未見雙J管或顯示雙J管位置上移，末端未顯露于膀胱內(nèi)或雙J管管周附著較多結(jié)石，預(yù)估直接拔管會造成嚴(yán)重損傷的患者；⑸膀胱容量過小，在60ml以下的患者；⑹處于經(jīng)期的女性患者；⑺因各種原因?qū)е碌墓顷P(guān)節(jié)畸形或肌肉病變而無法采取截石位的患者。 將滿足研究條件的就診患者隨機分為實驗組（即應(yīng)用自制改良環(huán)套式取管器拔管組）與對照組（即應(yīng)用傳統(tǒng)活檢鉗拔管組）。收集兩組研究對象的年齡、性別、置管病因、雙J管位置等相關(guān)資料，研究過程中選取拔管操作時間、拔管過程疼痛程度[采用視覺模擬評分（visual analog scale，VAS)系統(tǒng)評估]、拔管操作后首次排尿是否為肉眼血尿、拔管后恢復(fù)正常排尿所需時間及隨訪得到的拔管后第1、2、3天晨尿尿常規(guī)化驗結(jié)果等相關(guān)資料作為觀察指標(biāo)。采用SPSS16.0軟件對收集到的資料進行統(tǒng)計學(xué)處理及分析。 結(jié)果：1實驗組與對照組在性別、年齡、置管位置方面的差異不顯著，（P0.05）,因此可以排除性別、年齡、置管位置不同對實驗觀察指標(biāo)的影響。 2實驗組拔管操作時間平均為59.57±2.564s，對照組拔管操作時間平均為67.13±3.815s，兩者比較差異無統(tǒng)計學(xué)意義（P0.05）。 3通過對實驗組與對照組VSA測定值的比較，兩組差異有統(tǒng)計學(xué)意義（P0.05），依據(jù)Mean Rank實驗組=55.25，Mean Rank對照組=65.75，可以得出實驗組受試對象疼痛程度低于對照組。 4實驗組與對照組拔管操作后首次排尿為肉眼血尿患者構(gòu)成比，差異有統(tǒng)計學(xué)意義（P0.05），且實驗組拔管操作后首次排尿為肉眼血尿的患者所占的比例低于對照組。 5實驗組拔管后恢復(fù)到正常排尿的時間平均為41.88±1.445h，對照組拔管后恢復(fù)到正常排尿的時間平均為47.65±1.513h，兩者差異有統(tǒng)計學(xué)意義（P0.05），，且實驗組患者拔管后恢復(fù)正常排尿所需時間少于對照組。 6實驗組與對照組拔管后患泌尿系感染人數(shù)的構(gòu)成比之間的差異無統(tǒng)計學(xué)意義（P0.05）。 結(jié)論： 1通過對兩種拔管方法的對比研究，發(fā)現(xiàn)改良環(huán)套式拔管法能減輕患者在操作過程中經(jīng)受的痛苦，降低出血風(fēng)險，縮短拔管操作后恢復(fù)至正常排尿所需的時間。 2對于改良環(huán)套式拔管法能否縮短操作時間，能否降低患者拔管后泌尿系感染的風(fēng)險，將來需進一步擴大樣本量，并優(yōu)化隨訪方案來進一步探討。
[Abstract]:Objective : With the popularization and development of the technique and concept in urological surgery , more and more intraluminal devices and consumables were used in clinic , and the double J tube was one of them .

Methods : From September 2013 to January 2014 , 120 patients who came to our hospital were removed by cystoscope double J tube . The criteria of exclusion were as follows : ( 1 ) the age of the patients is less than 18 years old or more than 65 years old , or the age is more than 18 years old , but there is feeling , cognition and communication disorder ;
( 2 ) the patient has definite anti - coagulation medicine and analgesic medicine application history in the near term ;
( 3 ) Patients with other diseases which may lead to hematuria , cystospasm or symptoms of lower urinary tract irritation , such as benign prostatic hyperplasia ( size II and above ) , prostate cancer , urinary tract infection , overactive prostate ( OAB ) , etc . ;
( 4 ) Review abdominal KUB plain film or urinary system B ultrasound before operation , report that no double J tube or double J tube position is removed , and the distal end is not exposed to the bladder or double J tube circumference to attach more calculus , and it is estimated that the direct extraction tube can cause serious injury ;
( 5 ) The bladder capacity is too small to be below 60ml ;
( 6 ) Female patients in menstrual period ;
( 7 ) Patients with osteoarticular deformity or muscle disease due to various reasons cannot be taken to take the stones .

Patients who met the conditions of study were randomly divided into two groups : experimental group ( i.e . , self - made modified ring - sleeve type tube taking - out group ) and control group ( i.e . , traditional biopsy forceps extraction group ) . The data collected were analyzed statistically by SPSS 16.0 software .

Results : There was no significant difference in sex , age and location between experimental group and control group ( P0.05 ) .

In the experimental group , the operation time was 59.57 鹵 2.564s , the operation time of the control group was 67.13 鹵 3.85 s , the difference was not statistically significant ( P0.05 ) .

3 Through comparison between the experimental group and the control group , the difference of the two groups was statistically significant ( P0.05 ) . According to the Mean Rank test group = 55.25 , Mean Rank Control = 65.75 , it was concluded that the degree of pain in the experimental group was lower than that of the control group .

There was significant difference between the experimental group and the control group ( P0.05 ) , and the proportion of patients with gross hematuria was lower than that of the control group .

In the experimental group , the average time of recovery to normal urination was 41.88 鹵 1.445 h , the average time of recovery from the control group to normal urination was 47.65 鹵 1.513h , the difference was statistically significant ( P0.05 ) .

There was no significant difference between experimental group and control group ( P0.05 ) .

Conclusion :

1 Through the comparative study of the two methods of extraction , it is found that the improved ring - sleeve tube - pulling method can reduce the pain experienced by the patient during operation , reduce the risk of bleeding , shorten the time required to restore normal urination after the extraction operation .

2 To improve the operation time and reduce the risk of urinary tract infection after the withdrawal of the patient , the sample size should be further expanded in the future , and the follow - up scheme is optimized for further discussion .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699

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