輸尿管結石患者行輸尿管鏡碎石手術之相關照護

泌尿系統如腎臟、輸尿管、膀胱、尿道有結石產生時，稱為尿路結石。好發年齡為30-60歲，主要危險因子包含了男性、高嘌呤飲食、多坐少動、飲水不足、憋尿及反覆尿路感染。當結石由腎臟掉落並卡在輸尿管即為輸尿管結石，易引起劇烈腰痛、腹痛、頻尿、血尿、解尿困難、發燒，嚴重時會造成腎臟功能損傷，因而突顯了妥善治療與照護之重要性。輸尿管鏡碎石取石術及雙J導管之置入雖有輸尿管黏膜破裂、狹窄與感染等併發症之風險，但此法為治療輸尿管結石最有效的方法之一，且可顯著降低住院天數及併發症之發生。置放雙J導管之目的為引流尿液和血塊，恢復輸尿管通暢，並預防輸尿管再狹窄，但有下泌尿道症狀之併發症，臨床多輔以藥物治療來緩解雙J導管留置衍生的合併症。輸尿管鏡碎石術之護理重點有二大方向，手術前，護理人員須謹慎評估及緩解疼痛，確認病患瞭解手術目的及合併症；手術後，除監測意識狀態、生命徵象等病情變化外，雙J導管的留置、併發症之覺察與預防、居家照護以及預防結石復發之衛教更顯重要。本文透由實證文獻探討輸尿管結石及輸尿管鏡碎石術後之護理，期望本文可提供相關領域之臨床醫護人員照護患者之參考依據。

關鍵字

輸尿管結石；輸尿管鏡碎石術；雙J導管；下泌尿道症狀；護理

並列摘要

Urolithiasis, known as stones found in the urinary systems, including the kidney, ureter, bladder, or urethra. It frequently occurs in age 30 to 60-year-old, the majority of risk factors encompass male gender, purine-rich foods, lack of exercise and water intake insufficient, holding back urine, but also repeated urinary tract infection. When the kidney stones downward migration and stuck in the ureter, named ureteral stone. It leads to severe flank pain, abdominal pain, frequency, hematuria, dysuria, fever, as well as obstructive uropathy and results in acute kidney injury consequently. It points out the importance of providing adequate nursing management. Although the ureterorenoscopic lithotripsy with double-J stenting could lead to ureteral mucosal injury, perforation, stenosis, or infection, still it is one of the most effective treatments for ureteral stone. Moreover, it can reduce the days of hospital stay and lower the complication rate. The purpose of double-J stenting is to prevent an obstructive uropathy related to the stone fragment, and prevent postoperative ureteral stricture or re-stenosis. But it could result in lower urinary tract symptoms, which can be relief by medication clinically. Pre- and postoperative nursing management plays a significant role in such circumstances, such as evaluate the pain condition rigorously, and make sure the patient was well-informed regarding the purposes and complications prior the ureterorenoscopic lithotripsy. Moreover, except for close monitor vital signs and general conditions postoperatively, individualized education regarding double-J stenting care, complication awareness and prevention, domestic management, and stone recurrence prevention are more crucial. Since the relevant literature in Taiwan is still lacking, we hope this article can help clinicians and nurses provide a better quality of management.

並列關鍵字

ureteral stone ； ureterorenoscopic lithotripsy (URSL) ； double J catheter ； Lower urinary tract symptoms ； nursing

參考文獻

蘇淑芬、吳孟珊、張君伃（2019）。探討合併藥物治療對雙 J 導管置入患者疼痛及泌尿症狀之成效-系統性文獻回顧。榮總護理，36（3），296-307。[Su, S.F., Wu, M.S., & Jhang, J. Y. (2019).The Efficacy of Combined Medicine Treatment on Pain and Urinary Symptoms of Patients with Ureteral Double-J Catheters: A Systematic Review. Journal of Veterans General hospital nursing, 36(3), 296-307.] doi: 10.6142/VGHN.201909_36(3).0009.

Abdelaziz, A. Y., Fouda, W. B., Mosharafa, A. A., Abelrasoul, M. A., Fayyad, A., & Fawzi, K. (2018). Forgotten ureteral stents: Risk factors, complications and management. African Journal of Urology, 24(1), 28-33. doi:10.1016/j.afju.2017.09.005.

Abt, D., Warzinek, E., Schmid, H. P., Haile, S. R., & Engeler, D. S. (2015). Influence of patient education on morbidity caused by ureteral stents. International Journal of Urology, 22(7), 679-683. doi: 10.1111/iju.12782.

Castro, E. P., Osther, P. J., Jinga, V., Razvi, H., Stravodimos, K. G., Parikh, K. (2014). Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: The clinical research office of the endourological society ureteroscopy global study. European Urology, 66(1), 102-109. doi: 10.1016/j.eururo.2014.01.011.

Cepeda, M., Mainez, J. A., de la Cruz, B., & Amón, J. H. (2016). Indications and morbidity associated with double J catheters. Archivos espanoles de urologia, 69(8), 462–470.

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輸尿管結石患者行輸尿管鏡碎石手術之相關照護

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