摘要
目的总结可弯曲的真空辅助输尿管导引鞘在逆行肾内碎石术治疗上尿路结石中的初步应用经验。方法回顾性分析2021年8—9月江西省人民医院收治的11例上尿路结石患者的临床资料,男6例,女5例。平均年龄48(32~72)岁。平均结石长径15.5(11~20)mm。平均结石体积1958(1108~4036)mm^(3)。肾结石10例,输尿管上段结石1例。2例存在多个肾盏结石。2例术前预先留置输尿管支架管。肾积水Grignon分级Ⅰ级9例,Ⅱ级2例。所有患者均行逆行肾内碎石术,术中均使用F12/14可弯曲的真空辅助输尿管导引鞘,放置方法同传统输尿管导引鞘。可弯曲的真空辅助输尿管导引鞘能随输尿管软镜的弯曲而被动弯曲(弯曲角度>90°),同时具有连接负压吸引的功能。术中应用可弯曲的输尿管导引鞘最大限度地跟随输尿管软镜接近目标结石。术后常规留置F6双J管2~4周。记录手术时间、术后并发症、结石体积清除率等。术后第1天复查低剂量CT测量结石体积。结石体积清除率=(1-残留结石体积/术前结石体积)×100%。结果所有手术均一期顺利完成,术中均顺利应用可弯曲的真空辅助输尿管导引鞘。平均手术时间57.1(34~90)min。术后第1天平均结石体积清除率98.9%(94.8%~100.0%),其中7例无残留结石,4例存在残留结石。平均血红蛋白下降值0.6(0~11)g/L。术后1例出现呕吐,均未出现发热。术后2~4周拔除输尿管支架,4例残留结石者拔除输尿管支架后复查B超示已无残留结石。结论逆行肾内碎石术中应用可弯曲的真空辅助输尿管导引鞘安全可行。可弯曲的真空辅助输尿管导引鞘可跟随输尿管软镜伸入至肾盂、肾盏内,真空辅助功能可降低结石残留率。
Objective Objectives To introduce the preliminary experience of flexible vacuum-assisted ureteral access sheath(FV-UAS)in the treatment of upper urinary calculi in retrograde intrarenal lithotripsy(RIRS).Methods The clinical data of 11 patients with upper urinary calculi who were treated in Jiangxi Provincial People's Hospital from August to September 2021 were analyzed retrospectively.There were 6 males and 5 females,with the mean age of 48 years(32-72 years),the mean size of stone of 15.5 mm(11-20mm),and the mean stone volume of 1958 mm^(3)(1108-4036 mm^(3)),including 1 case with upper ureteral calculi,10 cases with renal calculi,and 2 cases with calculi in multiple renal calyces.Ureteral stents were placed in 2 cases preoperatively.There were 2 cases of gradeⅡhydronephrosis according to Grignon classification.All patients were treated by retrograde intrarenal lithotripsy,and the FV-UAS(F12/14)was used during the operation.FV-UAS can be passively bent(>90°)with the bending of the flexible ureteroscopy(f-URS),and connect vacuum suction devices.The method of placing the FV-UAS during the operation was the same as traditional ureteral access sheath.The FV-UAS should be as close to the target stone as possible by the f-URS during the operation.F6 ureteral stent was routinely indwelled for 2-4 weeks.The operation time,postoperative complications,and stone volume clearance rate were summarized and analyzed,and stone volume clearance rate was calculated as(1-residual stone volume/preoperative stone volume)×100%.The stone volume was obtained by CT 3-D reconstruction preoperatively and first day postoperatively.Results All patients underwent RIRS successfully at the first stage,with the usage of FV-UAS(F12/14)during the operation.The mean operation time was 57.1 minutes(34-90 minutes),and the mean stone volume clearance rate was 98.9%(94.8%-100.0%)on the first day postoperatively.Seven cases reached 100.0%stone-free rate,and 4 cases presented residual calculi.The mean hemoglobin drop was 0.8 g/L,and 1 case presented
作者
陈玉军
匡仁锐
高亮
郑亮亮
可龙龙
陈捷
Chen Yujun;Kuang Renrui;Gao Liang;Zheng Liangliang;Ke Longlong;Chen Jie(Department of Urology,Jiangxi Provincial People’s Hospital Affiliated to Nanchang University,Nanchang 330006,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第6期447-450,共4页
Chinese Journal of Urology
基金
江西省卫生健康委员会科技计划项目(202210011)。
关键词
尿路结石
输尿管导引鞘
逆行肾内手术
Urinary calculi
Ureteral access sheath
Retrograde intrarenal surgery
