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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 432 -436. doi: 10.3877/cma.j.issn.1674-3253.2022.05.011

临床研究

一期软性输尿管镜治疗上尿路结石的置鞘成功率及疗效分析
林枫1, 陶水祥2, 王钢2, 徐家栋2, 林奕伟3, 郑祥义3,†()   
  1. 1. 310003　浙江大学医学院附属第一医院泌尿外科；312000　浙江，绍兴文理学院附属医院泌尿外科
    2. 312000　浙江，绍兴文理学院附属医院泌尿外科
    3. 310003　浙江大学医学院附属第一医院泌尿外科
  • 收稿日期:2021-10-08 出版日期:2022-10-01
  • 通信作者: 郑祥义

Analysis of success rate of ureteral access sheath insertion and efficacy of stage I flexible ureteroscopic lithotripsy for upper urinary calculi

Feng Lin1, Shuixiang Tao2, Gang Wang2, Jiadong Xu2, Yiwei Lin3, Xiangyi Zheng3,†()   

  1. 1. Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; Department of Urology, the Affiliated Hospital of Shaoxing University, Shaoxing 312000, China
    2. Department of Urology, the Affiliated Hospital of Shaoxing University, Shaoxing 312000, China
    3. Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
  • Received:2021-10-08 Published:2022-10-01
  • Corresponding author: Xiangyi Zheng
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林枫, 陶水祥, 王钢, 徐家栋, 林奕伟, 郑祥义. 一期软性输尿管镜治疗上尿路结石的置鞘成功率及疗效分析[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(05): 432-436.

Feng Lin, Shuixiang Tao, Gang Wang, Jiadong Xu, Yiwei Lin, Xiangyi Zheng. Analysis of success rate of ureteral access sheath insertion and efficacy of stage I flexible ureteroscopic lithotripsy for upper urinary calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(05): 432-436.

目的

探讨术前未预置双J管一期软性输尿管镜治疗上尿路结石置鞘成功率及临床疗效。

方法

回顾性分析2018年1月至2020年6月在绍兴文理学院附属医院行一期软性输尿管镜碎石的255例上尿路结石患者的临床资料，分析一期置鞘成功率、一期手术成功率、结石清除率及并发症发生情况。

结果

8.5 F软性输尿管镜碎石，一期置鞘总成功率为92.9%（237/255）。其中10/12 F组置鞘成功率91.6%（141/154例），置鞘成功和失败患者之间性别差异有统计学意义（P<0.05）；12/14 F组置鞘成功率95%（96/101例），置鞘成功和失败患者之间在术前肾积水和肾功能方面差异有统计学意义（P<0.05），进一步行多因素Logistic回归分析表明性别（P=0.014）是置鞘失败的独立危险因素。一期手术成功率为85.5%（218/255），术后3个月清石率88.5%（177/200）。总并发症发生率为23.5%（60/255），术中输尿管1级损伤25例，2级损伤6例，3级损伤1例；术后发热22例，其中全身炎症反应综合征5例，尿源性脓毒血症1例；出现包膜下血肿1例；出现肾功能不全5例；未出现感染性休克、输尿管石街和输尿管狭窄等严重并发症。

结论

不预留双J管一期软性输尿管镜碎石治疗也具有较高的置鞘成功率及手术成功率，清石率高，安全可靠，女性患者置鞘成功率更高。

关键词: 输尿管软镜, 疗效, 输尿管通道鞘, 性别
Objective

To investigate the success rate of ureteral access sheath (UAS) insertion and efficacy of stage I flexible ureteroscopic lithotripsy (f-URL) in treatment of upper urinary calculi without indwelling double-J stent previously.

Methods

A total of 255 patients with upper urinary calculi treated by stage I f-URL in our hospital from January 2018 to June 2020 were analyzed retrospectively. The success rate of UAS insertion and surgery, the stone-free rate and the incidence of complications were calculated.

Results

The success rate of UAS insertion was 92.9%(237/255), and the success rate of one-stage operation was 85.5%(218/255). The success rate of UAS insertion in 10/12 F group was 91.6%(141/154), there was significant difference in gender between successful and unsuccessful patients (P<0.05). The success rate of UAS insertion in 12/14 F group was 95%(96/101), there was significant difference in hydronephrosis and preoperative renal function between successful and unsuccessful patients. Further multivariate logistic regression analysis showed that gender (P=0.014) were the risk factors for the failure of UAS insertion.The stone-free rate was 88.5%(177/200) three month after the operation. The total complication rate was 23.5%(60/255). During operation, there were 25 cases of grade 1 ureteral injury, 6 cases of grade 2 ureteral injury and 1 case of grade 3 ureteral injury. There were 22 cases of postoperative fever, including 5 cases of systemic inflammatory response syndrome and 1 case of urosepsis. Subcapsular hematoma occurred in 1 case. There were 5 cases of renal insufficiency, but no serious complications such as septic shock, ureteral stone street and ureteral stricture.

Conclusion

Stage I f-URL without indwelling double-J stent has a high success rate of UAS insertion and surgery with a high stone-free rate, is also a safe and reliable procedure. Female patients are more likely to experience intraoperative success to insert UAS.

Key words: Flexible ureteroscope, Efficacy, Ureteral access sheath, Gender
表1 输尿管通道鞘放置成功与失败患者的相关临床资料比较
组别 例数 年龄[岁，(±s)] 性别(例) 身高[m，(±s)] BMI[kg/m2，(±s)] 结石最大径[cm，(±s)] 肾积水*(例) 通道鞘型号(例) 术前肾功能异常(例) 输尿管扭曲(例) 糖尿病(例)
男 女 无/轻度 中度 重度 10/12 F 12/14 F
成功组 237 49±14 165 72 1.54±0.44 23.4±4 1.27±0.52 213 21 3 141 96 55 4 25
失败组 18 50±12 17 1 1.66±0.09 24.1±3 1.11±0.35 14 3 1 13 5 7 1 1
统计值   t=-0.205 χ2=5.046 t=1.159 t=-0.806 t=1.195 Z=-1.615 χ2=1.133 χ2=1.465 - χ2=0.073
P值   0.838 0.025 0.247 0.421 0.233 0.106 0.287 0.226 0.309 0.768
表2 10/12 F组输尿管通道鞘放置成功与失败患者的相关临床资料比较
组别 例数 年龄[岁，(±s)] 性别(例) 身高[m，(±s)] BMI[kg/m2，(±s)] 结石最大径[cm，(±s)] 肾积水(例) 术前肾功能异常(例) 输尿管扭曲(例) 糖尿病(例)
男 女 无/轻度 中度 重度
成功组 141 49±12 99 42 1.68±0.05 23.9±2.7 1.14±0.45 132 9 0 30 3 17
失败组 13 44±12 13 0 1.66±0.07 23.6±4.7 1.02±0.31 12 1 0 3 1 1
统计值   t=1.412 χ2=3.929 t=0.569 t=0.261 t=1.003 Z=-0.183 χ2=0.000 - χ2=0.000
P值   0.16 0.047 0.570 0.798 0.317 0.855 1.000 0.300 0.986
表3 12/14 F组输尿管通道鞘放置成功与失败患者的相关临床资料比较
组别 例数 年龄[岁，(±s)] 性别(例) 身高[m，(±s)] BMI[kg/m2，(±s)] 结石最大径[cm，(±s)] 肾积水(例) 术前肾功能异常(例) 输尿管扭曲(例) 糖尿病(例)
男 女 无/轻度 中度 重度
成功组 96 50±12 66 30 1.67±0.08 24.3±3.4 1.44±0.56 81 12 3 25 1 8
失败组 5 60±13 4 1 1.66±0.04 23.2±1.9 1.38±0.36 2 2 1 4 0 0
统计值   t=-1.841 χ2=0.001 t=-0.284 t=0.744 t=0.26 Z=-2.578 χ2=4.381 - -
P值   0.069 0.793 0.777 0.459 0.795 0.010 0.036 1.000 1.000
表4 影响置鞘成功的危险因素Logistic回归分析结果
相关因素 回归系数 标准误 OR值 95%CI P值
年龄 0.016 0.022 1.016 0.973~1.061 0.480
性别 -3.027 1.237 0.048 0.004~0.548 0.014
身高 6.530 4.239 685.404 0.169~2782083.573 0.123
BMI 0.145 0.090 1.156 0.970~1.377 0.106
结石最大径 0.145 0.539 1.157 0.402~3.329 0.787
肾积水程度 -0.933 0.521 0.393 0.142~1.092 0.073
术前肾功能 0.586 0.650 1.798 0.503~6.424 0.367
输尿管扭曲 -1.253 1.250 0.286 0.023~3.307 0.316
糖尿病 0.560 1.099 1.751 0.203~15.094 0.610
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