一种新的输尿管球囊导管在输尿管镜钬激光碎石术中的临床应用  

Clinical application of a new ureteral balloon catheter in ureteroscopic holmium laser lithotripsy

作　　者：周萃星[1] 孙阳洋 朱俊栋 沈杰 毛庆岩[1] 陆皓[1] 薛冬[1] ZHOU Cuixing;SUN Yangyang;ZHU Jundong;SHEN Jie;MAO Qingyan;LU Hao;XUE Dong(Department of Urology,Third Affiliated Hospital of Soochow University,Changzhou,Jiangsu,213000,China)

机构地区：[1]常州市第一人民医院泌尿外科,江苏常州213000

出　　处：《临床泌尿外科杂志》2025年第3期270-274,共5页Journal of Clinical Urology

基　　金：江苏省自然科学基金(No:BK20200180,BK20211064);常州市科技计划项目(No:CE20235059,CJ20230051);常州市医学重点学科(No:CZXK202209);常州市十四五卫生健康高层次人才培养工程(No:2022260)。

摘　　要：目的:探讨一种在输尿管镜内使用的输尿管球囊导管,在输尿管镜钬激光碎石术中治疗输尿管结石的安全性和有效性。方法:分析2024年1月—2024年6月在常州市第一人民医院通过单中心随机对照试验纳入符合样本量要求的100例使用输尿管球囊导管在输尿管镜钬激光碎石术治疗输尿管结石的临床资料,将其作为试验组,选取同期常规手术100例为对照组。试验组男58例,女42例;年龄32~67岁,平均(43.3±15.6)岁;对照组男50例,女50例;年龄36~62岁,平均(41.5±16.8)岁。入选患者均为单侧输尿管结石,结石直径1.6~2.3 cm,平均(1.9±0.4) cm。试验组全身麻醉下采用在输尿管镜内直视下置入输尿管球囊导管,利用球囊导管的水囊腔完成扩张输尿管开口、封堵输尿管结石、改变结石位置等操作,常规步骤完成钬激光碎石,予以斑马导丝引导下双J管置入。对照组使用常规手术步骤斑马导丝引导输尿管镜钬激光碎石术治疗。记录2组手术的进镜时间、手术时间、住院时间。Clavien-Dindo分级系统分析2组的手术并发症情况。术后1个月复查腹部平片(kidney ureter bladder,KUB)和全腹部平扫CT,评估2组的结石清除率。结果:试验组输尿管镜的进镜时间、手术完成时间、Clavien-Dindo分级的手术并发症输尿管开口黏膜损伤、术后短暂血尿较对照组均减少,差异有统计学意义(P<0.05);术后1个月试验组的结石清除率较对照组升高(93%vs 84%),试验组输尿管上段结石的清除率较对照组明显升高(91.7%vs 79.4%),差异有统计学意义(P<0.05);2组住院时间比较差异无统计学意义(P>0.05)。结论:新的输尿管球囊导管在输尿管镜钬激光碎石术中操作简单,安全有效,在降低手术难度的同时能提高手术效率,减少手术并发症,临床实践中值得应用。Objective:To investigate the safety and efficacy of ureteroscopic balloon catheter in ureteroscopic holmium laser lithotripsy for ureteral calculi.Methods:The clinical data of 100 cases of ureteral calculi treated by ureteroscopic holmium laser lithotripsy with ureteral balloon catheter were retrospectively analyzed through a single-center randomized controlled trial in our hospital from January 2024 to June 2024.They were selected as the experimental group,and other 100 cases of conventional operation during the same period were selected as the control group.There were 58 males and 42 females in the experimental group,aged 32-67 years,with an average age of(43.3±15.6) years.The control group included 50 males and 50 females,aged 36-62 years,with an average age of(41.5±16.8) years.The selected cases were all unilateral ureteral calculi with a diameter of 1.6-2.3 cm and an average of(1.9±0.4) cm.In the experimental group,ureteral balloon catheter was inserted under general anesthesia under the direct view of ureteroscope,and the water capsule cavity of the balloon catheter was used to enlarge the ureteral opening,seal ureteral calculi,and change the position of calculi.Holmium laser lithotripsy was completed by routine steps,and double J tube implantation was performed under the guidance of zebra guide wire.The control group was treated with zebra-guided ureteroscopic holmium laser lithotripsy.The admission time,operation time and hospital stay of the two groups were recorded.The Clavien-Dindo grading system was used to analyze the operative complications of the two groups.Abdominal plain film and total abdominal plain CT were reviewed one month after operation to evaluate the stone clearance rate of the two groups.Results:In the experimental group,ureteroscopy entry time,operation completion time,Clavien-Dindo-grade surgical complications of ureteral opening mucosal injury,postoperative transient hematuria decreased compared with the control group,with statistical difference(P<0.05);One month after surgery,the

关 键 词：输尿管球囊导管 输尿管镜 碎石术 激光 

分 类 号：R693[医药卫生—泌尿科学]