输尿管镜在门诊患者应用价值分析

目的评价9.8F输尿管镜在门诊拔除双J管、输尿管插管、膀胱检查、尿道检查中的应用价值;输尿管硬镜临床广泛使用可替代膀胱镜检查和治疗。方法 2008年1月～2009年6月我院使用9.8Fwolf输尿管镜完成门诊腔内操作462例,操作包括拔除双J管227例,输尿管插管118例,膀胱检查89例,尿道检查28例。同期接受22Fstorze膀胱镜操作589例,操作包括拔除双J管113例,输尿管插管94例,膀胱检查340例,尿道检查42例。所有操作均在麻醉润滑剂利宁表麻3min后进行。所有接受输尿管镜操作的患者和同期结接受膀胱镜操作的患者接受问卷调查。问卷内容包含：术中VAS疼痛评分、术后VAS疼痛评分、术后排尿症状评分、术后并发症评估。结果接受输尿管镜462患者均顺利完成输尿管镜操作,平均操作时间3.7min（1～11min）,平均术中疼痛评分2.4分（1～3分）,平均术后疼痛0.8分（0～2分）,术后排尿症状评分3.5分（1～7分）。膀胱镜操作589例,平均操作时间7.4min（1～14min）,平均术中疼痛评分4.1分（2～7分）,平均术后疼痛3.2分（1～6分）,术后排尿症状评分5.5分（2～10分）。问卷调查结果提示接受输尿管镜操作的患者术中疼痛评分、术后疼痛评分、术后排尿症状评分明显低于接受膀胱镜操作的患者,P均〈0.05;而且术后并发症的发生率明显低于膀胱镜组。结论表麻下患者对输尿管镜的耐受程度明显优于膀胱镜,而输尿管镜的使用可以明显减少普通膀胱镜使用后并发症的发生率。因此,门诊输尿管镜临床广泛使用可替代膀胱镜检查和治疗。

Value of ureteroscopy in outpatients

Objective To evaluate the use of 9.8F ureteroscope in the out-patient double-J tube removal,ureteral catheterization,bladder examination and urethra examination and clinical extensive use of rigid ureteroscope as an alternative method for cystoscopy and treatment.Methods From January 2008 to June 2009,we performed cavity operation in 462 out-patients using 9.8F wolf ureteroscope in our hospital,Operations included the removal of double J tube 227 cases,ureteral catheterization 118 cases,bladder examination 89 cases and of urinary tract examination 28 cases.At the same time,accepted 22Fstorze cystoscopy operating 589 cases.The operation including the removal of double J tube 113 cases,ureteral catheterization 94 cases,bladder examination 340 cases,and urinary tract examination 42 cases.All operations were preformed after 3 minites of lubricant Lining surface anesthesia,and followed up to answer a questionnaire.Questionnaire included： intraoperative VAS pain score,postoperative VAS pain score,postoperative voiding symptom score,complications assessment.Results All operations were finished successful.Ureterscopy group： average operation duration 3.7 mins（1～11mins）,average in-operation pain score 2.4point（1～3point）,average post-operation pain score 0.8point（0～2point）,urinate symptom score 3.5point（1～7point）.Cystoscopy group： average operation duration 7.4 mins（1-14mins）,average in-operation pain score 4.1point（2～7point）,average post-operation pain score 3.2point（1～6point）,urinate symptom score 5.5point（2～10point）.Questionnaire result suggested that,compared with cystoscopy,ureterscopy could decrease the in-operation pain score,post-operation pain score,urinate symptom score（P0.05）,and probability of operational complications.Conclusion In process of surface anaesthesia,patients can accept ureterscopy more easier than cystoscopy.Compared with cystoscopy,ureterscopy can obviously reduce the post-opreation complications.So,for outpatient＇s application,ureterscopy may be a promising substitution of cystoscopy.