超细输尿管软镜(F7.5)与其他类型输尿管软镜模拟术中控制肾盂内压效果的对比研究  

A comparative study of the effect of super thin flexible ureteroscope(F7.5)and other types of flexible ureteroscope on the control of intrapelvic pressure

作　　者：秦鹏飞 方立[2] 黄挺 汪枫祺 宋柏杨 王正义 程跃[2] Qin Pengfei;Fang Li;Huang Ting;Wang Fengqi;Song Baiyang;Wang Zhengyi;Cheng Yue(School of Medicine,Ningbo University,Ningbo 315211,China;Department of Urology,Center of Urology and Nephrology,The First Affiliated Hospital of Ningbo University,Ningbo 315010,China)

机构地区：[1]宁波大学医学部,宁波315211 [2]宁波大学附属第一医院泌尿肾病中心泌尿外科,宁波315010

出　　处：《中华泌尿外科杂志》2023年第9期690-695,共6页Chinese Journal of Urology

摘　　要：目的比较F7.5输尿管软镜与其他型号输尿管软镜(F8.5、F9.0、F9.2、F9.6)在模拟手术中控制肾盂内压的效果。方法用F7.5超细软镜和其他4种(F8.5、F9.0、F9.2、F9.6)一次性电子软镜搭配3种输尿管导引鞘,形成15个镜鞘组合,实测各软镜真实外径并计算有效镜鞘比。在体外采用3D打印肾-输尿管模型,在模型中模拟软镜碎石术中的灌注,设置灌注压为50、100、150、200、250、300、350.400.450、500 cmH_(2)O(1 cmH_(2)O=0.098 kPa),测量不同灌注压下的肾盂内压及灌流率。绘制折线图并对肾盂内压与灌注压的关系进行线性回归分析。分别比较不同镜鞘组合间及不同软镜组间的肾盂内压。结果所有器械组合的镜鞘比范围为0.62~0.92,其中F7.5软镜与F10/12、F11/13、F12/14导引鞘组合的镜鞘比分别为0.75.0.68和0.62。各个镜鞘组合中的肾盂内压和灌流率与灌注压呈近似线性关系。F7.5软镜在搭配F10/12.F11/13和F12/14此3种镜鞘时均能提供40 cmH_(2)O以下的肾盂内压。在所有的镜鞘组合中,F12/14鞘-F7.5软镜组合在50 cmH_(2)O灌注压下产生了最低的肾盂内压(1.47 cmH_(2)O),并在500 cmH_(2)O灌注压下提供了最高的灌流率(74.24 ml/min)。当5种软镜搭配F10/12鞘时,仅F7.5软镜能全程保持安全的肾盂内压(其最高仅为25.90 cmH_(2)O)。以不同镜鞘比组合为分组变量的肾盂内压差异性分析结果显示,整体差异有统计学意义(P<0.05)。以不同软镜型号为分组变量的组间差异性分析结果示,F7.5软镜组较其他4组有明显更低的肾盂内压(P<0.05)。结论F7.5超细软镜由于显著降低了器械组合的镜鞘比,在体外模拟手术中控制肾盂内压的效果较F8.5、F9.0、F9.2、F9.6软镜更好,且能够在保证肾盂压力安全的前提下适配更细的导引鞘。Objective To compare the effect of F7.5 ureteroscope and other types of ureteroscope(F8.5,F9.0,F9.2,F9.6)in the control of intrapelvic pressure during operation.Methods F7.5 super thin flexible ureteroscope and other 4 kinds of disposable flexible ureteroscopes(F8.5,F9.0,F9.2,F9.6)were combined with 3 kinds of ureteral guidance sheaths to form 15 endoscope-sheath combinations.The real outer diameter of each flexible ureteroscope was measured and the effective ratio of endoscope-sheath diameter was calculated.The real outer diameter of each soft mirror was measured and the effective sheath ratio was calculated.The irrigation during lithotripsy was simulated in a 3D printed kidney model,the irrigation pressure of 50-500 cmH_(2)O was set,and the stable intrapelvic pressure and flow rate were measured.The line chart was drawn and the relationship between intrapelvic pressure and irrigation pressure was analyzed by linear regression.The intrapelvic pressure between different endoscope-sheath combinations and different endoscope groups were compared respectively.Results The ratio of endoscope-sheath diameter for all combinations ranges from 0.62 to 0.92,with 0.75,0.68 and 0.62 for the F7.5 flexible ureteroscopes and F10/12,F11/13 and F12/14 sheath combinations respectively.Intrapelvic pressure and flow rate showed an approximately linear relationship with irrigation pressure in all groups.The F7.5 flexible scope with the F10/12,F11/13 and F12/14 sheaths all provided intrapelvic pressures below 40 cmH_(2)O.The F12/14 sheath-F7.5 scope combination produced the lowest intrapelvic pressure of 1.47 cmH,0 at 50 cmH_(2)Oirrigation pressure and the highest flow rate of 74.24 ml/min at 500 cmH_(2)O irrigation pressure.When combined with the F10/12 sheath,only the F7.5 flexible scope was able to maintain a safe intrapelvic pressure of only 25.90 cmH_(2)Othroughout.Analysis of the variability of intrapelvic pressure using the combination of instruments as the grouping variable suggested a significant overall difference(P<0.05).An

关 键 词：输尿管镜 软性 肾盂内压 镜鞘比 输尿管导引鞘 

分 类 号：R692[医药卫生—泌尿科学]