[1]王田 王君 洪欣 王晓峰*.同期局麻下处理双J管膀胱端附壁结石致拔管困难[J].中国微创外科杂志,2020,01(11):1005-1007.
　Wang Tian,Wang Jun,Hong Xin,et al.Management for Extubation Difficulties Caused by Encrustations Attached to the Bladder End of Double J Stents by Singlestage Operation Under Local Anesthesia[J].Chinese Journal of Minimally Invasive Surgery,2020,01(11):1005-1007.
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同期局麻下处理双J管膀胱端附壁结石致拔管困难()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年11期
页码:
1005-1007
栏目:
临床研究
出版日期:
2020-11-25

文章信息/Info

Title:
Management for Extubation Difficulties Caused by Encrustations Attached to the Bladder End of Double J Stents by Singlestage Operation Under Local Anesthesia
作者:
王田 王君 洪欣 王晓峰*
（北京大学国际医院泌尿外科，北京102206）
Author(s):
Wang Tian;  Wang Jun;  Hong Xin;  et al.
Department of Urology, Peking University International Hospital, Beijing 102206, China
关键词:
双J管; 附壁结石; 拔管困难
Keywords:
Double J stent; Encrustation; Extubation difficulty
文献标志码:
A
摘要:
目的探讨输尿管双J管膀胱端附壁结石致拔管困难的处理方法。 方法回顾性分析我院2017年6月~2020年5月26例因双J管膀胱端附壁结石导致拔管困难的临床资料。双J管放置时间1~18.5月，中位数8.75月。奥布卡因凝胶尿道局麻，先尝试经膀胱镜（或纤维膀胱镜）用异物钳将肾端猪尾环拉出尿道口，反复向尿道注入奥布卡因凝胶并保持一定张力持续缓慢牵拉双J管；如此方法失败，以肾镜代膀胱镜用大口径异物钳反复钳夹双J管表面附壁结石，将结石夹碎后取出双J管；如仍失败，经尿道膀胱镜（或纤维膀胱镜）下钬激光碎石，将双J管表面结石粉末化击碎后取出双J管。结果26例均局麻下一期拔除双J管，其中6例奥布卡因凝胶充分尿道局麻后取出，11例大口径异物钳夹碎双J管表面结石后取出，9例行钬激光碎石后取出。手术时间6~51 min，(20.6±8.1)min。无严重并发症。拔管后2周均复查泌尿系超声，未见肾积水或残留结石。结论双J管膀胱端附壁结石致拔管困难可以局麻下一期治疗，必要时使用大口径异物钳或钬激光碎石。
Abstract:
ObjectiveTo investigate the management of extubation difficulties caused by the encrustations attached to the bladder end of double J stents.MethodsA retrospective analysis was conducted on 26 cases who were accepted certain treatment under local anesthesia for treating the double J stent extubation difficulties due to the encrustations attached to the bladder end of tubes from June 2017 to May 2020. The median duration of double J stents indwelling was 8.75 months (range, 1-18.5 months). All the cases were treated under local anesthesia with oxybuvacaine gel. Firstly, the kidney end of tube was pulled out of the urethral opening through a cystoscopic or fibrocystoscopic operation. The oxybuvacaine gel was repeatedly injected into the urethra and the double J stent was pulled outward slowly. For patients failured of the first step, under the realtime monitoring of nephroscope instead of cystoscope, a large foreign body forceps were used to repeatedly clamp the calculi formed on the surface of the tube to perform a lithotripsy, in order to make the double J stent removed. Patients who could not remove the double J stent through the previous two steps were treated with transurethral holmium laser lithotripsy under local anesthesia, and the double J stent was removed after the encrustations formed on the surface of the tube were pulverized.ResultsAll the 26 patients got the double J stent removed through a successful onestage operation. The operative time ranged 6-51 min ［mean, (20.6±8.1) min］. The double J stents were pulled out after the urethra were fully anesthetized by oxybuvacaine gel in 6 patients and were extubated after a large foreign body forceps or holmium laser lithotripsy under local anesthesia in 11 and 9 patients, respectively. No significant complications occurred intraoperatively or postoperatively. Two weeks after extubation, all the patients were required to confirm neither hydronephrosis nor vesicle residual stones occurred in the examination of urinary system ultrasound.ConclusionPatients with double J stent extubation difficulties due to the encrustations attached to the bladder end of tubes can be solved by a singlestage operation under local anesthesia and a large foreign body forceps or holmium laser lithotripsy should be used if necessary.

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备注/Memo

备注/Memo:
*通讯作者，Email：wwxxff@sohu.com
更新日期/Last Update: 2021-02-07