可弯曲负压吸引鞘辅助输尿管软镜钬激光碎石术

doi:10.3877/cma.j.issn.1674-3253.2024.03.013

目的

探讨可弯曲负压吸引鞘在输尿管软镜钬激光碎石术中的安全性和有效性。

方法

回顾性分析2022年9月至2022年12月揭阳微创外科医院采用可弯曲负压吸引鞘辅助输尿管软镜钬激光碎石术方法治疗的128例上尿路结石患者临床资料。术中均采用外径11 F或12 F可弯曲负压吸引输尿管导引鞘，体外Y型接口连接负压吸引器，头端置于肾盂肾盏，在输尿管软镜引导下贴近目标结石，边打边吸，直至结石清除。术后常规留置5 F双J管2～4周。术后第1天及1～3个月复查CT或腹部平片了解结石清除率。分析手术时间、结石清除率，术中、术后并发症发生率等数据。

结果

128例患者一次性入鞘成功率97.7%；手术时间35～120 min，平均（78±27）min；术后平均住院时间（2.7±1.8）d。术后随访1～3个月结石清除率94.5%（121/128）。术后发热4例，鲜红色血尿伴血块1例，未出现其他严重并发症，并发症发生率3.9%，均获得治愈。

结论

可弯曲负压吸引鞘辅助输尿管软镜钬激光碎石术治疗上尿路结石安全有效。

关键词: 上尿路结石, 可弯曲负压吸引鞘, 输尿管软镜

Objective

To investigate the safety and efficacy of flexible negative pressure suction sheath-assisted flexible ureteroscopic holmium laser lithotripsy.

Methods

Retrospective analysis of the clinical data of 128 patients with upper urinary tract stones treated by flexible negative pressure suction sheath-assisted flexible ureteroscopic holmium laser lithotripsy at Jieyang Minimally Invasive Surgical Hospital from September 2022 to December 2022. During the surgery, 11 F or 12 F flexible negative pressure suction ureteral access sheath were used. The Y-shaped interface outside the body was connected to the negative pressure suction device, and the head end was placed in the renal pelvis and calyx. Under the guidance of flexible ureteroscopy, it was close to the target stone, and sucked out the gravel while crushing the stone until the stone was cleared. After surgery, the 5 F double J tube was routinely retained for 2-4 weeks. Review CT or abdominal plain film on the first day 1-3 months after surgery. The surgical time, stone clearance rate, and incidence of intraoperative and postoperative complications were analyzed.

Results

The success rate of one-time sheathing in 128 patients was 97.7%. The surgical time was 35-120 min with an average of (78±27) min; The average postoperative hospitalization time was (2.7±1.8) d. The stone clearance rate was 94.5%(121/128) after 1-3 months of postoperative follow-up. There was fever in 4 cases, bright red hematuria with blood clots in 1 case after operations, and no other serious complications occurred. The incidence of complications was 3.9%, and all patients were cured.

Conclusions

Flexible negative pressure suction sheath-assisted ureteroscopic holmium laser lithotripsy is safe and effective in the treatment of upper urinary tract stones.

Key words: Upper urinary tract calculi, Flexible negative pressure suction sheath, Flexible ureteroscope

图1　上尿路结石患者术前CT检查　图2　头端可弯曲负压吸引鞘　图3　钬激光碎石时可弯曲负压吸引鞘头端位于肾盏颈部　图4　结石从可弯曲负压吸引鞘吸出　图5　可弯曲负压吸引鞘在输尿管软镜碎石术中吸出结石　图6　上尿路结石患者术后次日CT检查注：2a为鞘整体观；2b为外鞘随"斑马镜"被动弯曲

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Flexible negative pressure suction sheath-assisted flexible ureteroscopic holmium laser lithotripsy

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Flexible negative pressure suction sheath-assisted flexible ureteroscopic holmium laser lithotripsy