离体猪肾模型中猪源纤维蛋白粘合剂在软性输尿管镜碎石术中辅助提高结石清除率的探索  

The assistant effects of porcine fibrin sealant in improving stone clearance rate in flexible ureteroscopy lithotripsy in ex vivo porcine kidney model

作　　者：陈玉军 刘伟[2] 习海波[2] 余月[2] 胡接平 邓君[2] 林龙辉 李晨 王共先[2] 傅斌[2] 周晓晨[2] Chen Yujun;Liu Wei;Xi Haibo;Yu Yue;Hu Jieping;Deng Jun;Lin Longhui;Li Chen;Wang Gongxian;Fu Bin;Zhou Xiaochen(Nanchang University Medical College,Nanchang 330006,China;Department of Urology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学医学院,南昌330006 [2]南昌大学第一附属医院泌尿外科,南昌330006

出　　处：《中华医学杂志》2022年第22期1660-1665,共6页National Medical Journal of China

基　　金：江西省科技厅应用培育计划(20212BAG70001)。

摘　　要：目的通过离体猪肾模型初步探讨使用猪源纤维蛋白粘合剂辅助清除肾结石碎片的可行性。方法在离体猪肾结石模型(含100 mg干燥的、≤1 mm人结石组分的猪肾6个,含100 mg干燥的、≤3 mm人结石组分的猪肾6个)中检验输尿管软镜配合12/14Fr输尿管导引鞘。实验组使用网篮-粘合剂取石(≤1 mm结石,n=3;≤3 mm结石,n=3);对照组仅使用网篮取石(≤1 mm结石,n=3;≤3 mm结石,n=3),对比两组的取石效果、结石清除率和操作时长等。收集健康人尿液,将猪源纤维蛋白粘合剂形成的凝胶放入其中,观察其特性。结果猪源纤维蛋白粘合剂能在生理盐水和尿液中形成凝胶并黏附包裹结石碎片。≤1 mm结石者实验组与对照组的操作时长分别为(14.0±4.2)和(29.0±0.7)min,(P<0.05),结石清除率分别为(90.9±1.4)%和(48.4±15.7)%(P<0.05);≤3 mm结石者实验组与对照组的操作时长分别为(12.8±4.0)和(30.0±0)min(P<0.05),结石清除率分别为(91.1±5.0)%和(20.7±8.0)%,(P<0.05)。凝胶在健康人尿液和生理盐水中37℃静置24 h自行溶解。结论浓度适宜的猪源纤维蛋白粘合剂可用于辅助软镜碎石术中清除小结石碎片。Objectives To investigate the feasibility of using a porcine fibrin sealant to wrap and remove kidney calculi fragments through an isolated porcine kidney model.Methods In the isolated porcine kidney stone model(implanted with 100 mg,air dried,≤1 mm human stone fragments,n=6;implanted with 100 mg,air dried,≤3 mm human stone fragments,n=6),the ureteral soft mirror combined with the 12/14Fr UAS was used to test the effect of stone extraction using only two stone extraction methods:basket extraction(control group,≤1 mm stone fragments,n=3;≤3 mm stone fragments,n=3)and basket-sealant extraction(test group,≤1 mm stone fragments,n=3;≤3 mm stone fragments,n=3).Compare the stone removal rate and operation time of the two stone retrieval methods.The sealant was put into urine of normal human and observed.Results Porcine Fibrin Sealant can form a gel in saline and urine and adhere and wrap stone fragments.The time of procedures of test(basket-sealant)and control(basket)group in kidneys implanted with≤1 mm stone fragments were(14.0±4.2)and(29.0±0.7)min(P<0.05)stone clearance rates were(90.9±1.4)%and(48.4±15.7)%(P<0.05),respectively.In kidneys implanted with≤3 mm fragments,time of procedures were(12.8±4.0)and(30.0±0)min(P<0.05)Stone clearance rates were(91.1±5.0)%and(20.7±8.0)%(P<0.05).The Sealant dissolves by itself in normal human urine and normal saline at 37℃for 24 hours.Conclusion The appropriate concentration of Porcine Fibrin Sealant assisted stone retrieval may become a new method for removing small stone fragments in retrograde intrarenal surgery.

关 键 词：肾结石 逆行肾内碎石术 动物实验 

分 类 号：R699[医药卫生—泌尿科学]