本文關(guān)鍵詞： 膀胱腫瘤 膀胱癌根治術(shù) 輸尿管支架 尿漏 腎盂腎炎　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過比較單J管和雙J管作為輸尿管支架在膀胱腫瘤根治性切除術(shù)中的安全性及其優(yōu)勢,為臨床輸尿管支架的選擇提供參考。方法:回顧性分析青島大學附屬青島市立醫(yī)院泌尿外科自2013年至2016年98例全膀胱手術(shù)患者的臨床資料,并按尿流改道的方式把行全膀胱手術(shù)的患者分成輸尿管皮膚造口術(shù)組(A組)、回腸膀胱術(shù)組(B組)及原位膀胱術(shù)(C組)三組。其中男性患者79例,女性患者19例。平均年齡(63.9±10.5)(32~82)歲。分別比較應用雙J管跟單J管在三組患者中尿漏發(fā)生率、尿路感染率、急性腎盂腎炎發(fā)生率(AP)、輸尿管支架發(fā)生脫落、回縮、移位的發(fā)生率以及住院天數(shù)的差異。結(jié)果:輸尿管皮膚造口術(shù)組、回腸膀胱術(shù)組、原位新膀胱組三組患者在年齡、性別、BMI、術(shù)前血紅蛋白、白蛋白值、相關(guān)的合并癥上沒有顯著差異。在輸尿管皮膚造口術(shù)組中,單J管組與雙J管組均未發(fā)生尿漏,尿路感染率分別為28.6%和26.7%。單J管組有1例發(fā)生腎盂腎炎,雙J管組有2例發(fā)生腎盂腎炎。差異無統(tǒng)計學意義。雙J管組有1例患者于術(shù)后2個月發(fā)生雙J管回縮。住院天數(shù)分別為19天(14 29d)和21天(9 39d)。在回腸膀胱術(shù)組中,單J管組有3例發(fā)生尿漏,雙J管組有2例發(fā)生尿漏,尿路感染率分別為36.8%和40%。兩組患者均未發(fā)生腎盂腎炎,亦無支架回縮、移位。住院天數(shù)分別為23天(11 42d)和23天(15 47d)。在原位新膀胱術(shù)組中,單J管組無尿瘺發(fā)生,雙J管組有4例發(fā)生尿漏,尿路感染率分別為(25%)和(62.5%)。兩者差異有統(tǒng)計學意義(P0.05)。單J管組未出現(xiàn)急性腎盂腎炎,雙J管組有4例發(fā)生腎盂腎炎(25%),差異有統(tǒng)計學意義(P0.05)。兩組未發(fā)生輸尿管支架移位。住院天數(shù)分別為20.5天(16 49d)和23.5天(16 65d)。在輸尿管皮膚造口術(shù)組、原位新膀胱術(shù)組中,單J管組的中位住院時間均明顯短于雙J管組。輸尿管皮膚造口術(shù)組分別為19天(14 29d)和21天(9 39d)(P=0.001)。原位新膀胱術(shù)組分別為20.5天(16 49d)和23.5天(16 65d)(P=0.001)。在回腸代膀胱組中單J管組與雙J管組中位住院時間相仿,為23天(范圍分別11 42d,15-47d)。結(jié)論:在全膀胱三種術(shù)式中,輸尿管腹壁造口術(shù)及回腸膀胱術(shù)式中應用單J與雙J管相比無明顯優(yōu)勢,在原位新膀胱術(shù)式中,與雙J管相比單J管可降低尿漏率及尿路感染率,縮短住院時間。值得在臨床中優(yōu)先選擇。
[Abstract]:Objective: to compare the safety and advantages of single J tube and double J tube as ureteral stent in radical resection of bladder tumor. Methods: the clinical data of 98 patients undergoing urinary surgery in Qingdao Municipal Hospital affiliated to Qingdao University from 2013 to 2016 were retrospectively analyzed. The patients undergoing total bladder surgery were divided into three groups: ureteral dermatostomy group (group A), ileal cystectomy group (group B) and in situ cystectomy group (group C). The average age of 19 female patients was 63.9 鹵10.5 years. The incidence of urinary leakage, urinary tract infection, acute pyelonephritis, ureteral stents and ureteral stents were compared in the three groups. Results: age, sex, hemoglobin and albumin were measured in three groups: ureteral dermatostomy group, ileal cystectomy group, orthotopic neobladder group. In the ureteral dermatostomy group, there were no urinary leakage in single J tube group and double J tube group, the urinary tract infection rate was 28.6% and 26.7.The single J tube group had one case of pyelonephritis. There were 2 cases of pyelonephritis in the double J tube group with no statistical significance. In the double J tube group, one patient had double J tube retraction 2 months after operation. The days of hospitalization were 19 days (14 days) and 21 days (9 days) and 39 days respectively. In the ileal bladder operation group, there was no significant difference between the two groups. Urinary leakage occurred in 3 cases in the single J tube group and in 2 cases in the double J tube group. The urinary tract infection rate was 36.8% and 40 respectively. No pyelonephritis and no stent retraction were found in both groups. The days of hospitalization were 23 days, 11 days, 42 days, and 23 days, 15 days and 47 days respectively. In the group of new bladder surgery in situ, there was no urine fistula in the single J tube group, 4 cases in the double J tube group, and 4 cases in the double J tube group. The urinary tract infection rate was 25% and 62.5% respectively. There was a significant difference between the two groups (P 0.05). There was no acute pyelonephritis in the single J tube group, and there was no acute pyelonephritis in the single J tube group. In the double J tube group, there were 4 cases of pyelonephritis and 25 cases of pyelonephritis, the difference was statistically significant (P 0.05). No transposition of ureteral stents occurred in the two groups. The days of hospitalization were 20.5 days (16 days) and 23.5 days (16 minutes 65 days). In the ureteral dermatostomy group, there was no change of ureteral stent. The median hospitalization time of single J tube group was significantly shorter than that of double J tube group, and that of ureteral dermatostomy group was 19 days (14 / 29 days) and 21 days (9 ~ 39days), and that of in situ neocystectomy group was 20.5 days (16 / 49d) and 23.5 / day / 1665days (P0.001) respectively. The median length of stay in the J tube group was similar to that in the double J tube group. Conclusion: the ureteral abdominal wall ostomy and ileal bladder operation have no obvious advantage over double J tube in the three types of total bladder operation, and in the new bladder operation in situ, there is no obvious advantage between single J and double J tube, and there is no significant difference between the three types of ureteral abdominal wall ostomy and ileal bladder operation. Compared with double J tube, single J tube can reduce urinary leakage rate and urinary tract infection rate and shorten hospitalization time.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.14

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