球囊扩张技术在输尿管镜碎石术中处理困难输尿管的有效性和安全性  

Efficacy and safety of balloon dilation technique during ureteroscopic lithotripsy with"difficult ureter"

作　　者：姬超岳 肖博[1] 胡卫国[1] 苏博兴[1] 刘宇保 宋海峰[1] 张刚[1] 白文洁 李建兴[1] Ji Chaoyue;Xiao Bo;Hu Weiguo;Su Boxing;Liu Yubao;Song Haifeng;Zhang Gang;Bai Wenjie;Li Jianxing(Department of Urology,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院泌尿外科,北京102218

出　　处：《中华泌尿外科杂志》2023年第2期109-114,共6页Chinese Journal of Urology

摘　　要：目的总结球囊扩张导管在输尿管镜碎石术中处理"困难输尿管"的初步临床应用经验,探讨该技术的有效性和安全性。方法回顾性分析2021年4月至2022年7月清华大学附属北京清华长庚医院收治的28例(30侧)上尿路结石患者的临床资料。男23例(82.1%),女5例(17.9%)。年龄(51.5±13.6)岁。30侧结石中,左侧20侧(66.7%),右侧10侧(33.3%);肾盂或肾盏结石7侧(23.3%),输尿管上段结石17侧(56.7%),输尿管下段结石6侧(20.0%)。结石最大径(9.4±4.2)mm;23侧(76.7%)术前合并肾积水。30侧中,拟行输尿管硬镜碎石取石术8侧(26.7%),输尿管软镜碎石取石术22侧(73.3%)。术中遇到"困难输尿管",即输尿管管腔细小而一期上镜或上鞘困难,一期使用球囊导管进行扩张,其中球囊直径4 mm 22侧,5 mm 8侧。经F8输尿管硬镜的工作通道逆行置入球囊导管,并直视下对管腔细小部位进行扩张。单次扩张完毕后撤出球囊导管,输尿管硬镜上镜探查评估扩张效果并决定是否继续进行上镜或上鞘操作。记录手术方式、术中"困难输尿管"发生阶段、输尿管细小部位、输尿管扩张球囊导管使用相关信息、扩张后输尿管损伤分级、手术时间、术中输尿管扩张球囊导管相关不良事件、术后结石清除率、输尿管支架管拔除时间等。结果本研究30侧手术中,29侧(96.7%)于上镜阶段操作困难,1侧(3.3%)于软镜鞘置入阶段出现困难。共扩张输尿管细小部位37处,其中18处位于输尿管膀胱壁内段,10处位于输尿管下段,2处位于输尿管中段,7处位于输尿管上段。单个部位球囊扩张次数均为1次,单次扩张中位时间3(0.5,5.0)min,单次扩张中位最大压力1215.9(1215.9,1443.9)kPa[12.0(12.0,14.3)atm]。扩张后输尿管损伤Ⅰ级28处,Ⅱ级8处,Ⅲ级1处。单侧手术时间(73.4±30.3)min。球囊扩张后上镜或置鞘成功28侧(93.3%);失败2侧(6.7%),均为球囊扩张后仍上镜失败,留置输尿管支架管二期手术。Objective To summarize the preliminary clinical experience of utilizing ureteral balloon dilation catheter in the treatment of"difficult ureter"during ureteroscopic lithotripsy,and to discuss the efficacy and safety of the technique.Methods Clinical data of 28 patients(30 sides)with upper urinary tract calculi admitted to Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from April 2021 to July 2022 were retrospectively analyzed.There were 23 males(82.1%)and 5 females(17.9%),with age of(51.5±13.6)years.Among the 30 sides,20(66.7%)on the left and 10(33.3%)were on the right.Calculi were either located in the renal pelvis or calyxes in 7 sides(23.3%),upper ureter in 17 sides(56.7%),and lower ureter in 6 sides(20.0%).The maximum diameter of the stones was(9.4±4.2)mm,and 23 sides(76.7%)were combined with hydronephrosis before surgery.When"difficult ureter"was encountered during the procedure,that is,it was difficult to insert ureteroscope or ureteral access sheath(UAS)due to small ureteral lumen,balloon catheter was used for dilation in the first stage,in which the balloon diameter was 4 mm on 22 sides and 5mm on 8 sides.The instrument was retrogradely inserted through the working channel of F8 semi-rigid ureteroscope,and the small site of the ureteral lumen was dilated under direct endoscopic view.After a single dilation,the balloon catheter was withdrawn,and the effect of dilation was evaluated by semi-rigid ureteroscopy to determine whether to proceed with the following procedures.The intraoperative data were recorded,including surgical method,stage of"difficult ureter"occurred,site of the small part of the ureter,related data of utilizing ureteral dilatation balloon catheter,grade of ureteral injury after dilatation(according to the 0-4 grading classification of endoscopic ureteral injuries),total operation time,balloon catheter-related adverse events,stone-free rate,and time of removing ureteral stents.Results Among the 30 sides,29(96.7%)had difficulty in the stage of ureteroscope insertion,

关 键 词：输尿管 输尿管镜术 碎石 困难输尿管 球囊扩张 

分 类 号：R699[医药卫生—泌尿科学]