智能控压控温软镜系统联合超脉冲光纤铥激光在上尿路结石治疗中的应用  

Study on the efficacy and safety of PT Scope combined with Thulium laser in the treatment of upper urinary tract stones

作　　者：吴至楷 刘成[1] 杨江华 李卓航[1] 赖聪 于浩[1] 许可慰[1] Wu Zhikai;Liu Cheng;Yang Jianghua;Li Zhuohang;Lai Cong;Yu Hao;Xu Kewei(Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华泌尿外科杂志》2024年第7期527-531,共5页Chinese Journal of Urology

基　　金：广州市科技计划项目(201803010029)。

摘　　要：目的评价智能控压控温软镜系统联合超脉冲光纤激光用于上尿路结石治疗的有效性和安全性。方法回顾性分析2024年2一4月于中山大学孙逸仙纪念医院行智能控压控温软镜系统联合超脉冲光纤激光碎石术的13例上尿路结石患者的临床资料。男7例,女6例;年龄(46±10)岁;结石累积直径(25.8±13.3)mm;肾下盏结石7例(53.8%),合并输尿管结石3例(23.1%)。术前尿培养阳性者4例(30.8%),尿常规白细胞>100个/μl者6例(46.2%)。对术前合并感染的患者根据药敏试验结果选用敏感抗菌药物治疗。智能控压控温软镜系统联合超脉冲光纤激光碎石术中参数设置:激光功率设置为45W(1.5J×30Hz,0.3J×150Hz),肾盂内压力阈值设置为30 mmHg(1mmHg=0.133kPa),温度阈值为43℃。术后留置双J管2~4周。结果13例均顺利完成手术,手术中位时间30(25,90)min。13例术中平均肾盂内压力范围为8~24mmHg,平均肾孟内温度25~34℃。1例患者术后出现发热(38℃),2例因术后疼痛需镇痛治疗,无其他术中、术后并发症。术后住院时间为(1.5±0.8)d。术后1个月评估结石清除率为84.6%(11/13)。结论智能控压控温软镜系统联合超脉冲光纤激光可有效控制肾盂内压及温度,结石清除率高,并发症发生率较低,是治疗上尿路结石安全、有效的方法。ObjectiveeTo evaluate the feasibility and safety of PT Scope(short for intelligent pressure and temperature controlled flexible ureteroscopy)combined with Thulium laser in the intracavitary treatment of upper urinary tract stones.Methods A retrospective analysis was conducted on the clinical data of 13 patients with upper urinary tract stones who were treated with PT Scope combined with Thulium laser lithotripsy in Sun Yat-Sen Memorial Hospital from February to April 2024.There were 7 males and 6 females.The patients had a mean age of(46±10)years old,with an accumulated stone diameter of(25.8±13.3)mm.There were 7 cases of lower calyx stones(53.8%),and 3 cases of concomitant ureteral stones(23.1%).Four patients(30.8%)had positive preoperative urine cultures,and six patients(46.2%)had leukocyte counts greater than 100 cells/μl in their urine tests.The Thulium laser power was set at 45 W(1.5 J at 30 Hz,0.3 J at 150 Hz).The renal pelvic pressure threshold was set at 30 mmHg(1 mmHg=0.133 kPa),and the temperature threshold at 43℃.Postoperatively,double J stents were placed for 2 to 4 weeks.Results All 13 patients successfully completed the surgery.The median operative time was 30(25,90)minutes.The intraoperative average renal pelvic pressure in these 13 patients ranged from 8 mmHg to 24 mmHg,and the average renal pelvic temperature ranged from 25℃to 34℃.Postoperatively,1 patient experienced a fever(38.0℃)and 2 patients required analgesic treatment due to postoperative pain.There were no other intraoperative or postoperative complications.The median postoperative hospital stay was(1.5±0.8)days.The stone-free rate of 1 month was 84.6%(11/13).Conclusions PT Scope combined with Thulium laser could effectively control renal pelvic pressure and temperature,achieve a high stone-free rate,and have a low complication rate.It is a safe and effective treatment for upper urinary tract stones.

关 键 词：尿路结石 输尿管软镜 肾盂内压力 肾盂内温度 光纤铥激光 

分 类 号：R699[医药卫生—泌尿科学]