可控负压吸引外鞘在输尿管软镜治疗肾结石中的应用  

Application of controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy in the treatment of renal calculi

作　　者：彭业平[1] 冯振华[1] 梁浩[1] 黄强[1] 黎郁武 PENG Yeping;FENG Zhenhua;LIANG Hao;HUANG Qiang;LI Yuwu(Department of Urology,Gaozhou Hospital,Gaozhou 525200,China)

机构地区：[1]广东省高州市人民医院泌尿外科,广东高州525200

出　　处：《现代泌尿外科杂志》2023年第3期197-200,共4页Journal of Modern Urology

基　　金：广东省茂名市科技计划项目(No.210406094550291)。

摘　　要：目的比较可控负压吸引外鞘与普通软镜外鞘在输尿管软镜联合钬激光治疗直径≤2 cm肾结石中的临床应用价值。方法选取85例肾结石患者作为研究对象,根据随机数字表法将患者分为负压组(45例)与普通组(40例)。比较两组手术时间、手术并发症、术后2 h感染指标、不良反应、治疗有效率及结石清除率。结果两组手术均能成功置入外鞘并进行钬激光碎石,负压组手术碎石时间较普通组短[(43.3±4.9)min vs.(66.2±5.8)min,P<0.05];普通组出现肾盂穿孔及输尿管撕裂并发症各1例(P>0.05);负压组术后2 h感染指标(降钙素原、血白细胞)升高情况显著低于普通组(P<0.05);负压组治疗有效率[91.11%(41/45)]及结石清除率[95.56%(43/45)]明显优于普通组[72.50%(29/40)、80.0%(32/40)];普通组术后肾绞痛、肉眼血尿和输尿管石街等不良反应总发生率高于负压组(P<0.05)。结论可控负压吸引外鞘在输尿管软镜治疗肾结石中疗效更佳,循环灌注保持术野清晰,减少手术时间的同时又提高了结石的清除率;负压吸引可使肾盂低压,避免感染性尿液入血。Objective To compare the clinical application value of controllable negative pressure suction outer sheath and ordinary flexible endoscope outer sheath in flexible ureteroscopic lithotripsy with holmium laser in the treatment of renal calculi less than or equal to 2 cm in diameter.Methods A total of 85 patients with renal calculi were selected and randomly divided into negative pressure group(n=45)and ordinary group(n=40).The operation time,complications,infection indexes 2 h after operation,adverse reactions,treatment efficacy and stone-clearance rate were compared between the two groups.Results The sheath was successfully implanted and holmium laser lithotripsy was performed in both groups.The negative pressure group had significantly shorter operation time than the ordinary group[(43.3±4.9)min vs.(66.2±5.8)min,P<0.05].There were 1 case of renal pelvis perforation and 1 case of ureteral laceration in the ordinary group(P>0.05).The increase of infection indexes(procalcitonin and leukocyte)2 h after operation were significantly lower in the negative pressure group than in the ordinary group(P<0.05).The efficacy in the negative pressure group was 91.11%(41/45)and the stone-clearance rate was 95.56%(43/45),which were significantly better than those in the ordinary group 72.50%(29/40)and 80%(32/40),respectively.The total incidence of adverse reactions such as renal colic,gross hematuria and ureteral stone street was higher in the ordinary group than in the negative pressure group(P<0.05).Conclusions Controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy is more effective,as the circulation perfusion keeps the operation field clear,reduces the operation time and improves the stone-clearance rate,while the negative pressure suction lowers the pelvis pressure to prevent infectious urine from entering the blood.

关 键 词：可控负压吸引外鞘 输尿管软镜 肾结石 钬激光碎石 泌尿系感染 

分 类 号：R692.4[医药卫生—泌尿科学]