测压吸石输尿管软镜引导鞘在输尿管软镜治疗肾结石中的应用  

Application of a Pressure-measuring and Stone-extracting Ureteral Access Sheath in Flexible Ureteroscopy For Renal Stones

作　　者：段康[1] 麻伟青[2] 邝丽新[1] 郭蕾[1] 刘齐贵[1] 王跃力[1] DUANG Kang MA Wei-qing KUANG Li-xin GUO Lei LIU Qi-gui WANG Yue-li(Dept. of Urology Dept. of Anesthesiology, Kunming Medical University Affiliated Kunming General Hospital of Chengdu Military Command, Kunming Yunnan 650032, China)

机构地区：[1]昆明医科大学附属成都军区昆明总医院泌尿外科,云南昆明650032 [2]昆明医科大学附属成都军区昆明总医院麻醉科,云南昆明650032

出　　处：《昆明医科大学学报》2016年第7期86-92,共7页Journal of Kunming Medical University

基　　金：成都军区昆明总医院院长基金资助项目(2012YG01)

摘　　要：目的探讨测压吸石输尿管扩张鞘(UAS)在输尿管软镜治疗肾结石术中的安全性及有效性.方法回顾性分析2014年11月至2015年9月成都军区昆明总医院泌尿外科行输尿管软镜钬激光碎石术(FURS)治疗肾结石病例98例,分为A、B 2组.A组病例软镜碎石术中使用新型测压吸石输尿管软镜引导鞘,术中联合负压吸引碎石;B组病例术中使用单纯测压型输尿管软镜引导鞘.术中设定灌注泵流量0.2 L/min,灌注压力上限设定为100 mm Hg,A组吸引负压为10 k Pa,术中根据视野清晰情况及肾内压力大小对灌注流量、压力及时进行调整.记录并对比分析两组病例术中肾内压力变化及走势和灌注时间.结果 2组患者均顺利完成手术.A组患者术中压力调整及时,手术全程肾内压力均低于B组患者,肾内平均压力为(10.88±5.911)mm Hg.B组患者术中平均肾内压力为(20.10±7.68)mm Hg,压力控制困难、不稳定.结论使用新型输尿管软镜引导鞘配合软镜手术,可使术中肾内压力人为可控,手术过程安全可行.Objective To investigate the application value of a pressure-measuring and stone-extracting ureteral access sheath （UAS） used together with negative pressure suction system during flexible ureteroscopy in the treatment of renal caculus. Methods A retrospective analysis was performed on the 98 cases of renal caculus who received flexible ureteroscopic holmium laser lithotripsy （FURS） in the Department of Urology of the Kunming General Hospital of Chengdu Military Command from November 2014 to September 2015, and the enrolled cases were divided into two groups： group A and group B. The new UAS was used in group A combined with vacuum suction during lithotripsy, and simple manometry type UAS was used in group B. The infusion pump flow rate of 0.2 L/min was set in the operation, the perfusion pressure limit was set to 100 mmHg, the suction pressure of group A was kPa. Perfusion flow rate and pressure was adjusted in a timely manner based on the clear vision and the internal pressure force on the kidney. Then we recorded and compared the internal pressure and variation trend of renal and perfusion time of two groups. Results Two groups of patients were successfully completed surgery .The renal pressures in group A were adjusted duly and were lower than the that in group B in the whole process of operation. The average renal pressure in group A was 10.88 ± 5.911mmHg. The average renal pressure in group B was 20.10± 7.68 mmHg,the pressure control was difficult and unsteady. Conclusion The new type of UAS in the flexible ureteroscopic holmium laser lithotripsy （FURS） can make the renal pressure in surgery controllable and is safe for the FURS.

关 键 词：输尿管软镜 软镜引导鞘 负压吸引 肾结石 测压 

分 类 号：R692.4[医药卫生—泌尿科学]