超细一次性电子输尿管软镜和普通一次性电子输尿管软镜治疗直径&lt;1.5 cm上尿路结石的随机对照研究

doi:10.3877/cma.j.issn.1674-3253.2026.02.006

目的

比较超细一次性电子输尿管软镜和普通一次性电子输尿管软镜治疗直径<1.5 cm上尿路结石的疗效。

方法

2024年10月至2025年1月我院70例直径<1.5 cm上尿路结石患者，随机分为两组，6.3 F免鞘组35例，采用6.3 F HugeMed一次性电子输尿管软镜激光碎石；7.5 F带鞘组35例，采用7.5 F普通一次性电子输尿管软镜激光碎石（带鞘）。比较两组的清石率、一期手术成功率、手术时间、术后住院时间等。

结果

6.3 F免鞘组比7.5 F带鞘组手术时间短，差异具有统计学意义（P=0.011）。6.3 F免鞘组一期手术成功率100%，7.5 F带鞘组91.43%，差异无统计学意义（P>0.05）。两组清石率、激光工作时间、术后第一天血红蛋白下降值、肌酐升高值、术后住院天数、术后并发症差异无统计学意义（P>0.05）。

结论

超细一次性电子输尿管软镜免鞘技术处理直径<1.5 cm上尿路结石安全、有效。

关键词: 一次性电子输尿管软镜, 输尿管引导鞘, 肾盂内压, 上尿路结石

Objective

To compare the effect of super fine disposable digital flexible ureteroscope and ordinary disposable digital flexible ureteroscope in the treatment of upper urinary tract stones with diameter <1.5 cm.

Methods

From October 2024 to January 2025, 70 patients with diameter <1.5 cm upper urinary tract calculi in our hospital were randomly divided into two groups, 35 patients in 6.3 F sheathless group were treated with 6.3 F HugeMed disposable electronic ureteroscopic laser lithotripsy. In the 7.5 F sheathed group, 35 cases were treated with 7.5 F common disposable electronic ureteroscope laser lithotripsy. The stone free rate, the success rate of the first stage operation, the operation time and the postoperative hospital stay were compared between the two groups.

Results

The operation time of 6.3 F sheathless group was shorter than that of 7.5 F sheathed group, with significant difference (P=0.011). The success rate of the first stage operation was 100% in the 6.3 F sheathless group and 91.43% in the 7.5 F sheathed group, with no significant difference (P>0.05). There were no significant differences in stone free rate, laser working time, hemoglobin decline on the first day after surgery, creatinine increase, postoperative hospitalization days and postoperative complications between the two groups (P>0.05).

Conclusion

It is safe and effective to treat upper urinary tract stones with diameter <1.5 cm by super fine disposable electronic ureteroscope.

Key words: Disposable digital flexible ureteroscope, Ureteral access sheaths, Renal pelvic pressure, Upper urinary tract stone

表1 两组上尿路结石患者术前一般资料比较

组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	性别[例(%)]		结石位置[例(%)]		肾积水[例(%)]			泌尿系感染[例(%)]
组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	女	男	肾盂	输尿管	无	轻度	中或重度	是	否
6.3 F组	35	51.86±12.89	22.75±3.77	1.21±0.23	16(45.71)	19(54.29)	21(60.00)	14(40.00)	28(80.00)	6(17.14)	1(2.86)	5(14.29)	30(85.71)
7.5 F组	35	52.77±11.34	22.34±3.02	1.29±0.19	14(40.00)	21(60.00)	19(54.29)	16(45.71)	26(74.29)	7(20.00)	2(5.71)	6(17.14)	29(82.86)
统计值		t=0.315	t=0.503	t=1.452	χ²=0.230		χ²=0.233		Z=0.603			χ²=0.107
P值		0.754	0.612	0.151	0.629		0.629		0.547			0.742

表1 两组上尿路结石患者术前一般资料比较

组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	性别[例(%)]		结石位置[例(%)]		肾积水[例(%)]			泌尿系感染[例(%)]
组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	女	男	肾盂	输尿管	无	轻度	中或重度	是	否
6.3 F组	35	51.86±12.89	22.75±3.77	1.21±0.23	16(45.71)	19(54.29)	21(60.00)	14(40.00)	28(80.00)	6(17.14)	1(2.86)	5(14.29)	30(85.71)
7.5 F组	35	52.77±11.34	22.34±3.02	1.29±0.19	14(40.00)	21(60.00)	19(54.29)	16(45.71)	26(74.29)	7(20.00)	2(5.71)	6(17.14)	29(82.86)
统计值		t=0.315	t=0.503	t=1.452	χ²=0.230		χ²=0.233		Z=0.603			χ²=0.107
P值		0.754	0.612	0.151	0.629		0.629		0.547			0.742

图1 HugeMed一次性电子输尿管软镜外观

表2 上尿路结石患者术中、术后情况比较

组别	例数	手术时间[min，(±s)]	激光工作时间[min，(±s)]	术后住院天数[d，(±s)]	术后第一天血红蛋白下降值[g/L，(±s)]	术后第一天血肌酐升高值[μmoI/L，(±s)]	一期手术成功率例(%)]
6.3 F组	35	50.45±19.34	22.47±6.33	1.37±0.49	5.15±2.55	10.16±5.25	35 (100)
7.5 F组	35	60.52±12.47	23.53±5.66	1.57±0.61	4.85±2.37	8.35±4.64	32 (91.43)
统计值		t=2.589	t=0.741	t=1.515	t=0.515	t=1.530	χ²=1.393
P值		0.011	0.462	0.134	0.609	0.131	0.238
组别	即刻清石率[例(%)]	最终清石率[例(%)]	并发症[例(%)]		结石成分[例(%)]
组别	即刻清石率[例(%)]	最终清石率[例(%)]	无	Clavien Ⅰ	草酸钙结石	尿酸结石	感染性结石	混合
6.3 F组	30 (85.71)	34 (97.14)	32 (91.43)	3 (8.57)	25 (71.43)	2 (5.71)	5 (14.29)	3 (8.57)
7.5 F组	29 (82.86)	33 (94.29)	31 (88.57)	4 (11.43)	29 (82.86)	0 (0)	4 (11.43)	2 (5.71)
统计值	χ²=0.108	χ²=0.348	χ²=0.158		χ²=1.296
P值	0.743	0.555	0.691		0.255

表2 上尿路结石患者术中、术后情况比较

组别	例数	手术时间[min，(±s)]	激光工作时间[min，(±s)]	术后住院天数[d，(±s)]	术后第一天血红蛋白下降值[g/L，(±s)]	术后第一天血肌酐升高值[μmoI/L，(±s)]	一期手术成功率例(%)]
6.3 F组	35	50.45±19.34	22.47±6.33	1.37±0.49	5.15±2.55	10.16±5.25	35 (100)
7.5 F组	35	60.52±12.47	23.53±5.66	1.57±0.61	4.85±2.37	8.35±4.64	32 (91.43)
统计值		t=2.589	t=0.741	t=1.515	t=0.515	t=1.530	χ²=1.393
P值		0.011	0.462	0.134	0.609	0.131	0.238
组别	即刻清石率[例(%)]	最终清石率[例(%)]	并发症[例(%)]		结石成分[例(%)]
组别	即刻清石率[例(%)]	最终清石率[例(%)]	无	Clavien Ⅰ	草酸钙结石	尿酸结石	感染性结石	混合
6.3 F组	30 (85.71)	34 (97.14)	32 (91.43)	3 (8.57)	25 (71.43)	2 (5.71)	5 (14.29)	3 (8.57)
7.5 F组	29 (82.86)	33 (94.29)	31 (88.57)	4 (11.43)	29 (82.86)	0 (0)	4 (11.43)	2 (5.71)
统计值	χ²=0.108	χ²=0.348	χ²=0.158		χ²=1.296
P值	0.743	0.555	0.691		0.255

[1]	Doizi S, Kamphuis G, Giusti G, et al. First clinical evaluation of a new single-use flexible ureteroscope (LithoVue™): a European prospective multicentric feasibility study[J]. World J Urol, 2017, 35(5): 809-818. DOI: 10.1007/s00345-016-1936-x.
[2]	Ofstead CL, Heymann OL, Quick MR, et al. The effectiveness of sterilization for flexible ureteroscopes: a real-world study[J]. Am J Infect Control, 2017, 45(8): 888-895. DOI: 10.1016/j.ajic.2017.03.016.
[3]	孟令超, 廖文彪, 熊云鹤, 等. 国产一次性电子输尿管软镜联合负压吸引鞘治疗单侧重复肾重复输尿管畸形合并上尿路结石的疗效分析[J]. 重庆医科大学学报, 2024, 49(6): 655-659. DOI: 10.13406/j.cnki.cyxb.003523.
[4]	Lua A, Tan LRL, Panthier F, et al. Optimal deflection techniques for flexible and navigable suction ureteral access sheaths (FANS): a comparative in vitro PEARLS analysis[J]. World J Urol, 2024, 42(1): 606. DOI: 10.1007/s00345-024-05297-3.
[5]	Chen H, Xiao J, Ge J, et al. Clinical efficacy analysis of tip-flexible suctioning ureteral access sheath combined with disposable flexible ureteroscope to treat 2-4 cm renal stones[J]. Int Urol Nephrol, 2024, 56(10): 3193-3199. DOI: 10.1007/s11255-024-04072-y.
[6]	Patel N, Akhavein A, Hinck B, et al. Tipless nitinol stone baskets: comparison of penetration force, radial dilation force, opening dynamics, and deflection[J]. Urology, 2017, 103: 256-260. DOI: 10.1016/j.urology.2017.01.010.
[7]	Tang X, Wu S, Li Z, et al. Comparison of thulium fiber laser versus holmium laser in ureteroscopic lithotripsy: a meta-analysis and systematic review[J]. BMC Urol, 2024, 24(1): 44. DOI: 10.1186/s12894-024-01419-6.
[8]	苏博兴, 肖博, 胡卫国, 等. 输尿管软镜一期上鞘失败率及相关临床因素分析[J]. 现代泌尿外科杂志, 2022, 27(11): 912-916. DOI: 10.3969/j.issn.1009‐8291.2022.11.005.
[9]	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): 1414-1417. DOI: 10.1089/end.2014.0215.
[10]	Vanlangendonck R, Landman J. Ureteral access strategies: pro-access sheath[J]. Urol Clin North Am, 2004, 31(1): 71-81. DOI: 10.1016/S0094-0143(03)00095-8.
[11]	Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery[J]. J Urol, 2013, 189(2): 580-584. DOI: 10.1016/j.juro.2012.08.197.
[12]	Guzelburc V, Guven S, Boz MY, et al. Intraoperative evaluation of ureteral access sheath-related injuries using post-ureteroscopic lesion scale[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(1): 23-26. DOI: 10.1089/lap.2015.0294.
[13]	Monga M, Bodie J, Ercole B. Is there a role for small-diameter ureteral access sheaths? Impact on irrigant flow and intrapelvic pressures[J]. Urology, 2004, 64(3): 439-441; discussion441-2. DOI: 10.1016/j.urology.2004.04.060.
[14]	Huang J, Zhao Z, AlSmadi JK, et al. Use of the ureteral access sheath during ureteroscopy: a systematic review and meta-analysis[J]. PLoS One, 2018, 13(2): e0193600. DOI: 10.1371/journal.pone.0193600.
[15]	Panthier F, Kwok JL, Tzou DT, et al. What is the definition of stone dust and how does it compare with clinically insignificant residual fragments? A comprehensive review[J]. World J Urol, 2024, 42(1): 292. DOI: 10.1007/s00345-024-04993-4.
[16]	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. DOI: 10.1007/s00345-015-1582-8.
[17]	Michel MS, Honeck P, Alken P. Conventional high pressure versus newly developed continuous-flow ureterorenoscope: urodynamic pressure evaluation of the renal pelvis and flow capacity[J]. J Endourol, 2008, 22(5): 1083-1085. DOI: 10.1089/end.2008.0016.
[18]	Noureldin YA, Kallidonis P, Ntasiotis P, et al. The effect of irrigation power and ureteral access sheath diameter on the maximal intra-pelvic pressure during ureteroscopy: in vivo experimental study in a live anesthetized pig[J]. J Endourol, 2019, 33(9): 725-729. DOI: 10.1089/end.2019.0317.
[19]	Cruz JACS, Danilovic A, Vicentini FC, et al. Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review[J]. Int Braz J Urol, 2024, 50(3): 346-358. DOI: 10.1590/s1677-5538.ibju.2024.9907.
[20]	Samaras A, Tatanis V, Peteinaris A, et al. The evaluation of intrarenal pressure using a novel single-use flexible ureteroscope with live intrarenal pressure monitoring-an experimental study in porcine models[J]. Life, 2024, 14(9): 1060. DOI: 10.3390/life14091060.
[21]	Haas CR, Li G, Hyams ES, et al. Delayed decompression of obstructing stones with urinary tract infection is associated with increased odds of death[J]. J Urol, 2020, 204(6): 1256-1262. DOI: 10.1097/JU.0000000000001182.

[1]	韩亮, 叶云翔, 张玉艳, 张世科, 周高翔, 周宇豪, 李舒珏, 曾滔, 曾国华, 乔庐东, 吴文起. 上尿路结石合并尿真菌培养阳性患者的诊治经验[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(03): 340-345.
[2]	莫淇舟, 苏劲, 黄健, 李健维, 李思宁, 柳建军. 智能控压输尿管软镜碎石吸引取石术在直径10～25 mm上尿路结石中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 497-502.
[3]	麦子结, 曾学晴, 张乾升, 刘永达. 输尿管软镜术后严重出血治疗的初步探索[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 366-371.
[4]	詹留松, 刘百川, 赵建朋, 薛国详. 可弯曲负压吸引鞘辅助输尿管软镜钬激光碎石术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 271-276.
[5]	李云智, 蒋晓峰, 金铭, 杨江华, 李海斌, 赵盟杰, 刘冬, 高国静, 孟繁超, 崔功静, 廖晓星. 输尿管软镜碎石术治疗累计直径>2 cm上尿路结石一期清石率影响因素及预测模型建立[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 58-63.
[6]	方钟进, 黄华生, 陈早庆, 郁兆存, 郑哲明, 谢永康, 陈仲宁, 邹演辉, 刘乾海, 陈镇宏. 负压组合式输尿管镜联合输尿管软镜与经皮肾镜治疗复杂性肾结石的比较[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 601-604.
[7]	龙卫兵, 刘晓冰, 易仁政, 邹德博, 蒋玉斌, 陈亮, 谢超群, 刘红叶, 粟周华, 张雄峰, 李麒麟. CT、B超预定位"三步法"经皮肾镜治疗上尿路结石[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 587-592.
[8]	陈美仁, 戴逸骅, 张茹, 戴英波. "蛙泳"俯卧位在经皮肾镜术中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 581-586.
[9]	阿不力孜·司马义, 艾合买提·艾买尔, 张小安, 雷鹏, 塔来提·塔依尔, 亚力坤·阿力木, 唐矛. 超声引导经皮肾镜碎石取石术在儿童上尿路结石中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(03): 239-243.
[10]	李协照, 徐桂彬, 袁耀基, 蔡志煅, 朱锐, 梁斯扬, 庄浩铨, 李逊. 上尿路结石合并血液肿瘤的诊治体会（附13例报告）[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(06): 493-496.
[11]	闻俊军, 彭林杰, 钟文. 肾盂低压并高效清石的增强版超微经皮肾镜技术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(02): 108-112.
[12]	王珩, 王军起, 黄永斌, 张海涛, 刘兆飞, 毛鹏飞, 聂锐志, 徐向军. 两种探针超声碎石术治疗复杂性上尿路结石的临床效果分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(04): 254-257.
[13]	刘成, 李卓航, 李奎庆, 刘皓, 许可慰. 斜跨位一期行一侧经皮肾镜联合对侧输尿管镜治疗双侧上尿路结石的疗效分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(05): 301-303.
[14]	刘东, 玉苏甫·阿克木, 李凯, 阿布都赛米·阿布都热依木, 和军, 李水学. 输尿管软镜钬激光碎石术治疗婴幼儿上尿路结石[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(02): 99-102.
[15]	赵文锋, 贾建业, 张弋, 夏溟, 董洋, 韩从辉, 金思彤, 李建波, 贾志刚, 刘鹏飞, 许长宝, 程跃. 体外冲击波碎石术治疗儿童上尿路结石的现况调查[J/OL]. 中华临床医师杂志(电子版), 2025, 19(04): 243-247.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

A randomized controlled study of super fine disposable digital flexible ureteroscope versus ordinary disposable digital flexible ureteroscope in the treatment of upper urinary tract stones with diameter <1.5 cm

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

A randomized controlled study of super fine disposable digital flexible ureteroscope versus ordinary disposable digital flexible ureteroscope in the treatment of upper urinary tract stones with diameter <1.5 cm