一次性输尿管软镜通路鞘两种置入深度的临床研究

doi:10.3877/cma.j.issn.1674-3253.2023.05.012

目的

探究两种置鞘深度下一次性输尿管软镜治疗肾结石的临床疗效对比。

方法

回顾性分析山西医科大学第三医院2020年12月至2021年12月行一次性输尿管软镜治疗肾结石的患者83例，根据患者身高决定使用长鞘或者短鞘。对于使用长鞘的患者，术中通路鞘置于肾盂输尿管连接部为L1组，术中通路鞘置于肾盂输尿管连接部以下5 cm处为L2组。同理，对于使用短鞘的患者，术中通路鞘置于肾盂输尿管连接部为S1组，术中通路鞘置于肾盂输尿管连接部以下5 cm处为S2组。分别对各组中患者的年龄、BMI等一般资料以及患者术前结石大小、平均CT值，术后肌酐水平、脓毒血症等并发症发生率，术后1个月结石清除率进行统计学分析。

结果

各组中患者的年龄、BMI等一般资料相比差异无统计学意义（P>0.05）；各组患者术前结石直径、平均CT值、是否留置双J管相比差异无统计学意义（P>0.05）；对于各组患者术后肌酐水平、腰痛、发热及脓毒血症发生率以及术后1个月结石清石率差异无统计学意义（P>0.05）。

结论

使用同一型号的一次性输尿管软镜通路鞘，术中鞘管两种置入深度治疗肾结石的临床疗效相当，手术过程中可常规将鞘管置于肾盂输尿管连接部以下5 cm处。

关键词: 通路鞘, 一次性，输尿管软镜, 深度, 肾结石, 肾盂输尿管连接部

Objective

To explore the clinical efficacy comparison of disposable flexible ureteroscope under two sheath depths.

Methods

A retrospective analysis of 83 patients who underwent disposable flexible ureteroscopic surgery for the treatment of renal calculi in the Third Hospital of Shanxi Medical University from December 2020 to December 2021 was performed, and the use of long sheath or short sheath was determined according to the patient's height. For patients using a long sheath, the ureteral access sheath was placed at the ureteropelvic junction as the L1 group, and the ureteral access sheath was placed 5 cm below the ureteropelvic junction as the L2 group. Similarly, for patients with a short sheath, the ureteral access sheath was placed at the ureteropelvic junction as the S1 group, and the ureteral access sheath was placed 5 cm below the ureteropelvic junction during the operation as the S2 group. The age, BMI and other general information of the patients in each group, as well as the preoperative stone size, average CT value, postoperative creatinine level, the incidence of complications such as sepsis, and the stone-free rate at 1 month after surgery were statistically analyzed.

Results

There were no significant differences in general information such as age and BMI among the groups (P>0.05); there was no significant difference in the preoperative stone diameter, average CT value, and whether the double J tube was indwelled between the groups (P>0.05); there was no significant difference in postoperative creatinine level, low back pain, fever and sepsis incidence rate and 1 month postoperative stone-free rate among the groups (P>0.05).

Conclusions

Using the same type of disposable flexible ureteroscope access sheath for the treatment of renal calculi, there is no significant difference in the clinical efficacy between the two insertion depths of the ureteral access sheath, and the sheath can be routinely placed 5 cm below the ureteropelvic junction during the operation.

Key words: Ureteral access sheath, Disposable, flexible ureteroscopy, Depth, Renal calculi, Ureteropelvic junction

表1 一次性输尿管软镜治疗肾结石患者一般资料

组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石直径[cm，(±s)]	结石CT值[Hu，(±s)]	术前留置双J管[例(%)]
L1组	20	50±12	23.3±2.3	1.42±0.56	767±127	4/20(20.0)
L2组	21	44±12	23.7±1.8	1.28±0.56	817±147	5/21(23.8)
统计值		t=0.121	t=0.339	t=0.053	t=0.703	χ²=1.000
P值		0.730	0.564	0.819	0.407	0.534
S1组	23	50±10	24.7±2.4	1.15±0.44	703±167	7/23(30.4)
S2组	19	51±11	25.3±2.8	1.25±0.44	765±196	4/19(21.1)
统计值		t=0.100	t=0.051	t=0.048	t=1.231	χ²=0.113
P值		0.754	0.822	0.827	0.274	0.737

表1 一次性输尿管软镜治疗肾结石患者一般资料

组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石直径[cm，(±s)]	结石CT值[Hu，(±s)]	术前留置双J管[例(%)]
L1组	20	50±12	23.3±2.3	1.42±0.56	767±127	4/20(20.0)
L2组	21	44±12	23.7±1.8	1.28±0.56	817±147	5/21(23.8)
统计值		t=0.121	t=0.339	t=0.053	t=0.703	χ²=1.000
P值		0.730	0.564	0.819	0.407	0.534
S1组	23	50±10	24.7±2.4	1.15±0.44	703±167	7/23(30.4)
S2组	19	51±11	25.3±2.8	1.25±0.44	765±196	4/19(21.1)
统计值		t=0.100	t=0.051	t=0.048	t=1.231	χ²=0.113
P值		0.754	0.822	0.827	0.274	0.737

表2 一次性输尿管软镜治疗肾结石患者术中及术后资料

组别	例数	手术时间[min，(±s)]	术后血肌酐水平[μmol/L，(±s)]	术后腰痛[例(%)]	术后发热[例(%)]	术后清石率[例(%)]
L1组	20	67±38	78±15	8/20(40.0)	5/20(25.0)	14/20(70.0)
L2组	21	65±28	74±13	10/21(47.6)	8/21(38.1)	16/21(76.2)
统计值		t=0.974	t=0.225	χ²=0.241	χ²=0.811	χ²=0.200
P值		0.330	0.638	0.623	0.368	0.655
S1组	23	66±26	73±11	10/23(43.5)	6/23(26.1)	19/23(82.6)
S2组	19	53±18	75±9	9/19(47.4)	8/19(42.1)	13/19(68.4)
统计值		t=3.647	t=0.878	χ²=0.064	χ²=1.201	χ²=0.505
P值		0.063	0.354	0.801	0.273	0.477

表2 一次性输尿管软镜治疗肾结石患者术中及术后资料

组别	例数	手术时间[min，(±s)]	术后血肌酐水平[μmol/L，(±s)]	术后腰痛[例(%)]	术后发热[例(%)]	术后清石率[例(%)]
L1组	20	67±38	78±15	8/20(40.0)	5/20(25.0)	14/20(70.0)
L2组	21	65±28	74±13	10/21(47.6)	8/21(38.1)	16/21(76.2)
统计值		t=0.974	t=0.225	χ²=0.241	χ²=0.811	χ²=0.200
P值		0.330	0.638	0.623	0.368	0.655
S1组	23	66±26	73±11	10/23(43.5)	6/23(26.1)	19/23(82.6)
S2组	19	53±18	75±9	9/19(47.4)	8/19(42.1)	13/19(68.4)
统计值		t=3.647	t=0.878	χ²=0.064	χ²=1.201	χ²=0.505
P值		0.063	0.354	0.801	0.273	0.477

[1]	那彦群, 叶章群, 孙颖浩, 等. 2014版中国泌尿外科诊断治疗指南[M].北京: 人民卫生出版社, 2013.
[2]	姚碧海, 黎承杨. 输尿管软镜技术及其治疗尿石症的临床研究进展[J]. 微创医学, 2021, 16(2): 255-259.
[3]	蒋祥新,蔡万松,闻立平.输尿管软镜鞘直视置入法钬激光碎石术一期治疗肾结石的临床分析[J].中华泌尿外科杂志, 2016, 37(12): 932-935.
[4]	刘卓,江弘炀,刘夏铭, 等.输尿管硬镜辅助的可视化输尿管通道鞘放置方法的初步应用[J].临床泌尿外科杂志, 2018, 33(07): 528-531.
[5]	Kaplan AG, Lipkin ME, Scales CD, et al. Use of ureteral access sheaths in ureteroscopy[J]. Nat Rev Urol, 2016, 13(3): 35-140.
[6]	杨嗣星, 陈志强. 软性输尿管镜术中国专家共识[J]. 中华泌尿外科杂志, 2016, (37)8: 561-565.
[7]	Breda A, Territo A, López-Martínez JM. Benefits and risks of ureteral access sheaths for retrograde renal access[J]. Curr Opin Urol, 2016, 26(1): 70-5.
[8]	Lima A, Reeves T, Geraghty R, et al. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period[J]. World J Urol, 2019(3): 1329-1333.
[9]	李小康, 毛云华, 肖东明等. 输尿管通路鞘辅助输尿管镜治疗输尿管结石的临床疗效分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(2): 113-116.
[10]	Shvero A, Herzberg H, Ziberman D, et al. Is it safe to use a ureteral access in an unstented ureter?[J]. BMC Urol, 2019, 19(1): 80.
[11]	Stern KL, Loftus CJ, Doizi S, et al. A prospective study analyzing the association between high-grade ureteral access sheath injuries and the formation of ureteral strictures[J]. Urology, 2019, 128: 38-41.
[12]	蒋立量, 杨嗣星. 输尿管通达鞘及其临床应用[J]. 微创泌尿外科杂志, 2017, 6(2): 124-128.
[13]	翟永鑫,塔怀峰,杨潇等.输尿管通道鞘在输尿管软镜碎石术中应用的研究进展[J].中国实验诊断学, 2022, 26(01): 133-137.
[14]	Mogilevkin Y, Sofer M, Margel D, et al. Predicting an effective ureteral access sheath insertion: a bicenter prospective study[J]. J Endourol, 2014, 28(12): 1414-7.
[15]	Auge BK, Pietrow PK, Lallas CD, et al. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation[J]. J Endourol, 2004, 18(1): 33-6.
[16]	Tokatli NZ, Sarica K, Kabakci AS, et al. Intra-renal pressures during ra-rirs (robotic assisted retrograde intra-renal surgery): a critical evaluation based on ureteral access sheath (uas) size and irrigation flow rate [J]. J Urol, 2017, 197(4): e691.
[17]	Rehman J, Monga M, Landman J, et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths[J]. Urology, 2003, 61: 713-718.
[18]	Türk C, Petrík A, Sarica K, et al．EAU Guidelines on interventional treatment for Urolithiasis[J]．Eur Urol, 2016, 69(3): 475-482.
[19]	Wong VK, Aminoltejari K, Almutairi K, et al. Controversies associated with ureteral access sheath placement during ureteroscopy[J]. Investig Clin Urol. 2020, 61(5): 455-463.
[20]	Assimos D, Krambeck A,Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline, PART I[J]. J Urol, 2016, 196(4): 1153-1160.
[21]	倪颖, 周金才, 王启明, 等.输尿管通道鞘状态与鞘内流速变化分析[J]. 中国内镜杂志, 2019, 25(5): 75-79.
[22]	李建兴, 肖博. 软性输尿管镜手术临床应用要点[J]. 临床泌尿外科杂志, 2018, 33(7): 507-510.
[23]	丘中笑, 邵勇. 输尿管鞘联合输尿管镜碎石术治疗复杂性输尿管结石疗效分析[J].现代实用医学, 2017, 29(10): 1286-1287.
[24]	Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? [J] J Urol, 2001, 165(3):789-793.
[25]	Traxer O, Wendt-Nordahl G, Sodha H, et al. Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath:The Clinical Research Office of the Endourological Society Ureteroscopy Global Study[J]．World J Urol, 2015, 33(12): 2137-2144.

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Clinical study on two insertion depths of disposable flexible ureteroscope access sheath

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Clinical study on two insertion depths of disposable flexible ureteroscope access sheath