输尿管肾盂清石镜在输尿管结石手术中应用的初步探索  

Preliminary exploration of the application of UreteroPyeloVisClear Catheter in ureteral stone surgery

作　　者：陈洋[1] 肖博[1] 黄海文 曾雪 丁天福 白文洁 李建兴[1] Chen Yang;Xiao Bo;Huang Haiwen;Zeng Xue;Ding Tianfu;Bai Wenjie;Li Jianxing(Department of Urology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,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、清华大学临床医学院,北京102218

出　　处：《中华泌尿外科杂志》2025年第1期44-48,共5页Chinese Journal of Urology

基　　金：北京市属医院科研培育计划项目(PX2025030);北京市医院管理中心临床医学发展专项经费资助(ZLRK202520)。

摘　　要：目的输尿管肾盂清石镜(VCC)在治疗输尿管结石中的初步应用结果。方法回顾性分析2023年11月至2024年3月清华大学附属北京清华长庚医院18例采用VCC治疗的输尿管结石患者的临床资料。男15例,女3例;年龄27~75岁,平均53岁。术前CT检查示输尿管结石最大径3~18 mm,平均9 mm;结石最大CT值260~1480 HU,平均870 HU;输尿管上、中、下段结石分别有3、8、7例。18例术前肌酐51~154μmol/L,平均108μmol/L;术前血红蛋白95~183 g/L,平均139 g/L。采用重力挂水灌注,所有患者均使用VCC联合钬激光碎石,必要时联合输尿管软镜碎石,术后常规留置双J管2周。分析围手术期及并发症情况。结果18例患者均使用VCC碎石,其中1例输尿管结石靠近肾盂输尿管连接处且被炎性息肉包裹,使用VCC将结石向上移至肾盂内使用输尿管软镜联合网篮碎石取石。18例手术时间为20~100 min,平均53 min;碎石时间为6~60 min,平均25.5 min。术后第1天患者血肌酐48~149μmol/L,平均93.7μmol/L;血红蛋白97~179 g/L,平均139.7 g/L;术后血肌酐与血红蛋白较术前无明显变化。术后住院时间为1~3 d,平均2 d。术后1例有发热,最高体温38.5℃,予抗感染治疗后体温恢复正常。术后疼痛视觉模拟评分(VAS)0分15例,2、3、4分各1例。未发生Clavien-Dindo≥Ⅱ级并发症。术后1个月复查CT,18例患者均未见输尿管结石,未见患侧肾积水。结论本研究结果表明,VCC治疗输尿管结石术后并发症发生率低,结石清除率高,是治疗输尿管结石有效且安全的方法。ObjectiveTo explore the preliminary results of using the UreteroPyeloVisClear Catheter(VCC)in the treatment of ureteral stones.MethodsA retrospective analysis was conducted on the clinical data of 18 patients with ureteral stones who underwent treatment with VCC at Beijing Tsinghua Changgung Hospital from November 2023 to March 2024.The cohort consisted of 15 men and 3 women,with a mean age of 53 years(range:27-75 years).The preoperative CT measurements showed that the mean maximum stone diameter was 9 mm(range:3-18 mm),and the mean maximum CT value of the stones was 870 HU(range:260-1480 HU).The distribution of stones was as follows:3 cases in the upper ureter,8 in the middle ureter,and 7 in the lower ureter.Gravity-assisted perfusion was used,and all patients underwent VCC combined with Holmium laser lithotripsy,with flexible ureteroscopy used if necessary.A ureteral stent was routinely placed for 2 weeks postoperatively.Perioperative conditions and complications were analyzed.ResultsAll 18 patients successfully underwent VCC lithotripsy,with one patient experiencing stone migration during the procedure.The average operation time was 53 minutes(range:20-100 minutes),and the average lithotripsy time was 25.5 minutes(range:6–60 minutes).There were no significant changes in serum creatinine or hemoglobin levels on the first postoperative day.The average hospital stay was 2 days(range:1–3 days).One patient experienced a fever(maximum temperature of 38.5℃),which resolved with antibiotic treatment.The visual analogue scale(VAS)scores on postoperative day 1 were 0 for 15 patients,2 for 1 patient,3 for 1 patient,and 4 for 1 patient.No complications of Clavien-Dindo gradeⅡor higher were observed.At 1-month follow-up,the stone-free rate(SFR)was 100%(18/18),and no hydronephrosis was observed in the affected kidney.ConclusionsThe results of this study indicates that VCC is a safe and effective method for treating ureteral stones,with a low incidence of postoperative complications and a high stone clearance rate.

关 键 词：输尿管结石 钬激光 输尿管镜碎石术 疗效 

分 类 号：R699.4[医药卫生—泌尿科学]