Pryor J L, Jenkins A D
Department of Urology, University of Virginia School of Medicine, Charlottesville.
J Urol. 1990 Mar;143(3):475-8. doi: 10.1016/s0022-5347(17)39993-7.
Double-pigtail stents are placed commonly in patients before extracorporeal shock wave lithotripsy to prevent ureteral obstruction from steinstrasse. The use of double-pigtail stents in lithotripsy patients with a moderate stone burden was studied in a prospective randomized trial. Patients with unilateral renal stone(s) with at least 1 diameter between 7 and 25 mm. were eligible for the study. Fifty patients were randomized to a control or stented group. Double-pigtail stents with an attached suture were placed immediately before extracorporeal shock wave lithotripsy in the stented group. Stents were removed by the patients 1 week after lithotripsy. A survey on pain and associated symptoms was completed by patients at 1 and 14 days after treatment. There was no statistical difference in flank or abdominal pain, nausea, vomiting, temperature or use of analgesics at 1 and 14 days after extracorporeal shock wave lithotripsy in the control and stented groups. All patients in the stented groups complained of side effects attributable to the stent including urinary frequency and urgency, bladder pain, hematuria and flank pain with urination. Of 25 patients with stents 7 (27%) had early removal because of severe irritation, early migration or accidental removal. Among the patients with follow-up x-rays 1 month after treatment 17 of 21 (81%) in the control group and 12 of 19 (63%) in the stented group showed no evidence of remaining stones. The use of double-pigtail stents is not beneficial in patients with a moderate stone burden. Double-pigtail stents are associated with considerable patient discomfort but no decrease in symptomatic ureteral obstruction or final stone eradication rate.
在进行体外冲击波碎石术之前，通常会为患者放置双猪尾支架，以防止铸型结石导致输尿管梗阻。在一项前瞻性随机试验中，对结石负荷中等的碎石术患者使用双猪尾支架的情况进行了研究。入选标准为患有单侧肾结石、至少有1个直径在7至25毫米之间的患者。50名患者被随机分为对照组或支架置入组。在支架置入组中，在体外冲击波碎石术前立即放置带有缝线的双猪尾支架。碎石术后1周，患者自行取出支架。治疗后1天和14天，患者完成了关于疼痛及相关症状的调查。对照组和支架置入组在体外冲击波碎石术后1天和14天，在胁腹或腹痛、恶心、呕吐、体温或使用镇痛药方面无统计学差异。支架置入组的所有患者均抱怨有与支架相关的副作用，包括尿频、尿急、膀胱疼痛、血尿和排尿时胁腹疼痛。在25名置入支架的患者中，有7名（27%）因严重刺激、早期移位或意外取出而提前取出支架。在治疗后1个月进行随访X光检查的患者中，对照组21名患者中有17名（81%），支架置入组19名患者中有12名（63%）未显示有残留结石的迹象。对于结石负荷中等的患者，使用双猪尾支架并无益处。双猪尾支架会给患者带来相当大的不适，但在有症状的输尿管梗阻或最终结石清除率方面并无降低。
