头端可弯负压吸引鞘辅助输尿管软镜治疗感染性肾结石的安全性和有效性分析  

Efficacy and safety of tip-bendable suction ureteral access sheath assisted flexible ureteroscopic lithotripsy in the treatment of infectious renal calculi

作　　者：彭忠胜 王思源 刁呈文[1] 陈岳[1] 齐士勇[1] 权昌益[1] PENG Zhongsheng;WANG Siyuan;DIAO Chengwen;CHEN Yue;QI Shiyong;QUAN Changyi(Department of Urology,Second Hospital of Tianjin Medical University,Tianjin,300211,China)

机构地区：[1]天津医科大学第二医院泌尿外科,天津300211

出　　处：《临床泌尿外科杂志》2025年第2期120-123,127,共5页Journal of Clinical Urology

基　　金：天津市教委科研计划项目(No:2023ZD008)。

摘　　要：目的:探索头端可弯负压吸引鞘(tip-bendable suction ureteral access sheath,SUAS)辅助输尿管软镜碎石术(flexible ureteroscopic lithotripsy,FURL)应用于感染性肾结石治疗的有效性及安全性。方法:选取2022年10月—2024年10月天津医科大学第二医院治疗的80例感染性肾结石患者,根据是否采用SUAS辅助将上述患者分为研究组(40例)和对照组(40例),研究组采用SUAS辅助FURL,对照组采用传统输尿管软镜鞘辅助FURL。采用SPSS 25.0对2组患者基线资料、结石有关资料、术前感染及肾积水情况、手术相关资料、术后结石残留情况、术后感染指标、术后视觉模拟评分法(visual analogue scale,VAS)评分、术后并发症发生情况等进行分析。结果:研究组与对照组患者在人口学资料(年龄、性别、体重指数)、结石有关资料(结石侧别、结石负荷、结石CT值)及结石并发症(肾积水程度、肾功能不全)等方面比较差异无统计学意义(P>0.05);研究组手术时间为(43.38±18.72)min,少于对照组的(54.88±18.10)min,2组比较差异有统计学意义(P<0.05)。研究组患者术后感染相关指标(血白细胞计数、中性粒细胞百分比、C反应蛋白及降钙素原)、术后血红蛋白下降量、术后并发症发生率(肉眼血尿、发热及感染性休克等)、术后VAS评分及术后Clavien分级均低于对照组,2组比较差异有统计学意义(P<0.05);研究组术后即刻清石率(72.5%)及术后4周清石率(85.0%)均高于对照组即刻清石率(50.0%)及术后4周清石率(62.5%),2组比较差异有统计学意义(P<0.05)。结论:FURL辅助以SUAS应用于感染性肾结石的治疗,相比于传统输尿管软镜鞘不仅能够达到更高的清石率,更是能够在一定程度上缩短手术时间,减少严重感染、出血及剧烈疼痛等术后并发症的发生。Objective:To explore the efficacy and safety of tip-bendable suction ureteral access sheath(SUAS)assisted flexible ureteroscopic lithotripsy(FURL)in the treatment of infectious renal calculi.Methods:A retrospective study was conducted on 80 patients with infectious renal calculi treated in the Second Hospital of Tianjin Medical University from October 2022 to October 2024.According to whether the SUAS was used for assistance or not,the above patients were divided into a study group and a control group.The study group(n=40)adopted SUAS-assisted FURL,while the control group(n=40)adopted traditional flexible ureteroscopic sheath-assisted FURL.The baseline data,stone-related data,preoperative infection and hydronephrosis conditions,surgery-related data,postoperative residual stone conditions,postoperative infection indicators,postoperative visual analogue scale(VAS)scores,and postoperative complication occurrence of the above patients were analyzed.Results:There was no statistically significant difference between the study group and the control group in terms of demographic data(age,gender,body mass index),stone-related data(stone side,stone burden,stone CT value),or stone complications(degree of hydronephrosis,renal insufficiency),etc.(P>0.05).The operation time of the study group was(43.38±18.72)min,which was shorter than that of the control group([54.88±18.10]min),and the difference between the two groups was statistically significant(P<0.05).The postoperative infection-related indicators(white blood cell count,neutrophil percentage,C-reactive protein,and procalcitonin),the decrease in postoperative hemoglobin,the incidence of postoperative complications(gross hematuria,fever,septic shock,etc.),the postoperative VAS score,and the postoperative Clavien classification in the study group were all lower than those in the control group,and the differences between the two groups were statistically significant(P<0.05).The immediate stone clearance rate(72.5%)and the 4-week postoperative stone clearance rate(85.0%)in th

关 键 词：头端可弯负压吸引鞘 感染性肾结石 输尿管软镜碎石术 

分 类 号：R692.4[医药卫生—泌尿科学]