宫颈癌术前预置双J管在术后补充放疗前最佳拔管时间的临床研究

摘要

Objective To explore the optimum time of removal of preoperative double J stent before adjuvant radiotherapy in cervical cancer. Meth⁃ods A total of 90 patients with cervical cancer who underwent radical surgery between January 2014 and March 2015 were retrospectively analyzed. In addition,these recruited patients also underwent preoperative placement of double J stent and had them removed before the adjuvant radiotherapy. The patients were then divided into three groups based on the time of removal of double J stent. Group A(n=21)had the stent removed 2 to 4 weeks after the surgery;group B(n=46)had the stent removed 4 to 5 weeks after the surgery;group C(n=23)had the stent removed greater than or equal to 5 weeks after the surgery. The complications caused by stent placement and their improvement after stent removal were compared among the three groups. Finally,the optimum time of stent removal was determined. Results The overall incidence of complications caused by stent placement in group B(23.91%)was significantly lower(P<0.05)than that in group A(47.62%)and group C(56.52%). The most frequent among these complications were bladder irritation(8.70%)and fever(8.70%). The incidence of hydronephrosis exacerbation after stent removal in group A (28.57%)was significantly higher(P<0.05)than that in group B(6.52%)and group C(4.35%). All the other complications were alleviated or disappeared after the removal in all the three groups. There were no significant difference(P>0.05)among the three groups concerning glomerular filtration rate,serum urea nitrogen,and serum creatinine. Conclusion The incidence of complications caused by preoperative double J stent place⁃ment increased along with the duration of placement,but the exacerbation of hydronephrosis should be concerned if the stent is removed too early. Therefore,the optimal time of stent removal is 4 to 5 weeks after the surgery.%目的：探讨宫颈癌术前预置双J管在术后补充放疗前的最佳拔管时间。方法回顾性分析2014年1月至2015年3月因宫颈癌于我院行开腹或腹腔镜下宫颈癌根治术、术前预置双J管并于术后补充放疗前拔管的患者90例。按照拔出双J管的不同时间分为3组：术后2~<4周拔管组（A组），共21例；术后4~<5周拔管组（B组），共46例；术后≥5周拔管组（C组），共23例。比较各组间置管相关并发症及拔管后并发症的改善情况，以确定拔出双J管的最佳时间。结果 B组总体置管相关并发症发生率（23.91%）显著低于A组（47.62%）和C组（56.52%），差异有统计学意义（P<0.05），以膀胱刺激征和置管发热最常见，发生率均为8.70%。拔管后A组肾积水加重率（28.57%）显著高于B组（6.52%）和C组（4.35%），差异有统计学意义（P<0.05）；其余各组并发症均自行消失或好转。且3组比较，肾小球滤过率、血尿素氮及血清肌酐等方面的差异均无统计学意义（P>0.05）。结论宫颈癌术前预置的双J管随着置管时间的延长，其相关并发症发生率显著增加，然而拔管时间过早亦可引起肾积水加重，因此建议最佳拔管时间为术后4~5周。