输尿管硬镜辅助的可视化输尿管通道鞘放置方法的初步应用

刘卓; 江弘炀; 刘夏铭; Gaurab Pokhrel; 李聪; 王涛; 余虓; 王少刚; 刘继红

doi:10.13201/j.issn.1001-1420.2018.07.006

输尿管硬镜辅助的可视化输尿管通道鞘放置方法的初步应用

- 华中科技大学同济医学院附属同济医院泌尿外科(武汉, 430030)

详细信息

通讯作者: 余虓,E-mail:yujiuhu@163.com

中图分类号: R454;R691.4

收稿日期: 2018-05-29

Primary application of rigid ureteroscope aided visualized insertion of ureteral access sheath

- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

More Information

Corresponding author: YU Xiao, E-mail: yujiuhu@163.com

Received Date: 29 May 2018

摘要

摘要: 目的:为提高输尿管通道鞘(ureteral access sheath,UAS)放置过程的安全性和准确性,本研究尝试利用输尿管硬镜辅助实现置鞘过程的可视化,并与国内常用的徒手置鞘法进行对比,比较手术操作的安全性和有效性。方法:将94例符合纳入标准的肾结石或输尿管上段结石患者,随机分为A、B两组。A组患者采用输尿管硬镜辅助的可视化置鞘法:将14/12Fr 35cm UAS套在9.5Fr 43cm输尿管硬镜上,在直视下进镜并将UAS放置到输尿管合适位置,退出硬镜再进行软镜碎石术。B组患者采用无X线监视的徒手置鞘法。UAS置入后两组采用相同的技术进行碎石。记录术中UAS放置情况和时间、输尿管损伤情况,随访4¹2周,了解清石率及术后并发症情况。结果:与B组比较,A组UAS放置所需时间更短[(35.69±6.54) s vs.(55.71±10.58) s,P<0.05]。在术前预先留置双J管的患者中两组置鞘成功率均为100%,在术前未预先留置双J管的患者中B组置鞘成功率高于A组(83.33% vs.66.67%,P<0.05)。两组手术时间差异无统计学意义[(65.31±24.45) min vs.(67.42±21.34) min,P>0.05]。A组在术中发生输尿管1级损伤1例;B组在术中发生输尿管1级损伤4例,2级损伤1例;3级损伤1例,输尿管损伤发生率A组显著低于B组(2.08% vs.13.04%,P<0.05)。两组住院时间差异无统计学意义[(4.08±1.45) d vs.(4.16±1.37) d,P>0.05]。两组一期结石清除率差异无统计学意义(91.67% vs.89.13%,P>0.05)。结论:输尿管硬镜辅助的可视化置鞘法安全可行,可控性好,与徒手置鞘法相比能提高操作的安全性和准确性。局限性在于对于术前未预先留置双J管的患者,输尿管硬镜辅助的可视化置鞘法置鞘成功率有所降低。
- 泌尿系结石 /
- 输尿管软镜 /
- 钬激光碎石 /
- 可视化技术
Abstract: Method:To improve the safety and accuracy of the insertion of ureteral access sheath (UAS), we used rigid ureteroscope to visualize this process.We also compared the safety and effectiveness between the visualized technology and classical method.Method:Ninety-four consecutive patients with renal stone or upper ureteral calculi meeting the inclusion criteria were divided into two groups (group A and group B).UAS was placed with visualized technology in group A:the 14/12 Fr 35 cm UAS was worn on the 9.5 Fr 43 cm rigid ureteroscope and was placed into the ureter under direct vision.Lithotripsy was performed with flexible ureteroscope after removing rigid ureteroscope.UAS was inserted with safety wire guidance and without X-ray assistance in group B.Same lithotripsy technology was used after UAS placement in two groups.Time of UAS placement, ureteral injury, stone clearance rate and complications were recorded.The follow-up period was 4-12 weeks.Result:Compared with group B, time of UAS placement in group A was shorter[(35.69±6.54) s vs. (55.71±10.58) s, P<0.05].In patients with preoperative placement of double J ureteral catheter, the success rates of UAS placement in two groups were both 100%, whereas in patients without double J ureteral catheter, the success rate in group B was higher than that in group A (83.33% vs.66.67%, P<0.05).Operation time was similar in two groups[(65.31±24.45) min vs. (67.42±21.34) min, P>0.05].One patient in group A encountered grade 1 ureteral injury.However, in group B, 4 patients encountered grade 1 ureteral injury, 1 patient encountered grade 2 ureteral injury and 1 patient encountered grade 3 ureteral injury.The ureteral injury rate in group A was significantly lower than that in group B (2.08% vs.13.04%, P<0.05).Hospitalization time was similar in two groups[(4.08±1.45) d vs. (4.16±1.37) d, P>0.05].The stone clearance rates between two groups had no significant difference (91.67% vs.89.13%, P>0.05).Conclusion:Rigid ureteroscope aided visualized UAS insertion is feasible, controllable, and shows higher safety and accuracy compared with classical methods.The limitation of this new method is that in patients without preoperative placement of double J ureteral catheter, the success rate of UAS placement was lowered.
- urolithiasis /
- flexible ureteroscope /
- holmium laser lithotripsy /
- visualization technology

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