可弯曲负压吸引鞘联合输尿管软镜对比经皮肾镜治疗2~4 cm上尿路结石的临床疗效分析

丁美旋; 龚赫; 谢怡杰; 郑琦; 黄海超; 郑嘉欣; 段波; 王惠强; 白培德; 陈斌

doi:10.13201/j.issn.1001-1420.2025.04.003

可弯曲负压吸引鞘联合输尿管软镜对比经皮肾镜治疗2~4 cm上尿路结石的临床疗效分析

- 1.
  厦门大学附属第一医院泌尿外科(福建厦门，361003)
- 2.
  福建医科大学临床医学部
- 3.
  福建中医药大学
基金项目:
国家自然科学基金面上项目(No: 82370764);福建省自然科学基金面上项目(No: 2024J011361);厦门市医疗卫生指导性项目(No: 3502Z20244ZD1017)

详细信息

通讯作者: 陈斌，E-mail：chenbin5557@163.com

中图分类号: R691.4

收稿日期: 2025-01-25

刊出日期: 2025-04-06

Clinical efficacy of flexible and navigable suction ureteral access sheath combined with flexible ureteroscopic lithotripsy versus percutaneous nephrolithotomy in the treatment of 2-4 cm upper urinary tract stones

- 1.
  Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
- 2.
  School of Clinical Medicine, Fujian Medical University
- 3.
  Fujian University of Traditional Chinese Medicine

More Information

Corresponding author: CHEN Bin, E-mail: chenbin5557@163.com

Received Date: 25 January 2025

Publish Date: 06 April 2025

摘要

摘要: 目的探讨可弯曲负压吸引鞘(flexible and navigable suction ureteral access sheaths，FANS-UAS)联合输尿管软镜碎石术(flexible ureteroscopic lithotripsy，FURL)治疗2~4 cm上尿路结石的临床疗效和安全性。方法回顾性分析2022年1月—2023年11月于厦门大学附属第一医院泌尿外科接受治疗的294例2~4 cm上尿路结石患者的临床资料。分为FANS-UAS联合FURL组(114例)和经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)组(180例)，比较2组术前基线资料和手术疗效指标数据。结果 2组性别构成比、体重指数(body mass index，BMI)、结石大小、术前尿白细胞计数、术前尿培养等基线资料比较差异无统计学意义。FANS-UAS联合FURL组术中出血量[10(10，10) mL vs 50(5，100) mL]、术后血清降钙素原水平[0.020(0.020，0.033) ng/L vs 0.050(0.028，0.798) ng/L]、发热率(0.9% vs 11.7%)、术后住院时间[1(1，2) d vs 5(5，6) d]及疼痛视觉模拟评分[2(2，2)分vs 3(2，3)分]均明显低于PCNL组(P < 0.001)。FANS-UAS联合FURL组术后1 d清石率(stone free rate，SFR)(71.1% vs 73.9%)及1个月SFR(76.3% vs 81.7%)均与PCNL组相当(P>0.05)。结论在治疗2~4 cm上尿路结石方面，FANS-UAS联合FURL安全有效，能减少出血，患者发热、疼痛减少，术后恢复快，具有与PCNL相当的SFR，可作为一种PCNL替代方案。
- 上尿路结石 /
- 输尿管软镜碎石术 /
- 可弯曲负压吸引鞘 /
- 经皮肾镜取石术
Abstract: Objective To investigate the clinical efficacy and safety of flexible and navigable suction ureteral access sheath(FANS-UAS) combined with disposable flexible ureteroscopic lithotripsy(FURL) for the treatment of 2-4 cm large burden upper urinary tract stones.Methods The clinical data of 294 patients with 2-4 cm upper urinary tract stones treated in the Department of Urology of the First Affiliated Hospital of Xiamen University from January 2022 to November 2023 were retrospectively analyzed. They were divided into FANS-UAS combined with FURL group(114 cases) and percutaneous nephrolithotomy(PCNL) group(180 cases) according to the surgical methods, and the preoperative baseline data, surgical indexes, stone-related indexes, and postoperative hospitalization data of the two groups were compared.Results There were no significant statistical differences in baseline data between the two groups, including gender composition ratio, BMI, stone size, preoperative urine white blood cell count, or preoperative urine culture. In the FANS-UAS combined with FURL group, the intraoperative blood loss(10[10, 10] mL vs 50[5, 100] mL), postoperative serum PCT level(0.020[0.020, 0.033] ng/L vs 0.050[0.028, 0.798] ng/L), fever rate(0.9% vs 11.7%), postoperative hospital stay(1[1, 2] d vs 5[5, 6] d), and visual analogue scale for pain(2[2, 2] points vs 3[2, 3] points) were significantly lower than those in the PCNL group(P < 0.001). The stone free rate(SFR) on the first day after surgery(71.1% vs 73.9%) and the SFR one month after surgery(76.3% vs 81.7%) in the FANS-UAS combined with FURL group were comparable to those in the PCNL group(P>0.05).Conclusion In the treatment of upper urinary tract stones measuring 2-4 cm, the combination of FANS-UAS and FURL is safe and effective. It can reduce bleeding, decrease the incidence of fever and pain in patients, accelerate postoperative recovery, and achieve a stone free rate comparable to that of PCNL. Therefore, it can be regarded as an alternative to PCNL.
- upper urinary tract calculi /
- flexible ureteroscopic lithotripsy /
- flexible and navigable suction ureteral access sheath /
- percutaneous nephrolithotomy

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表 1 2组基线资料比较例(%)，M(Q₁，Q₃)

项目	FANS-UAS联合FURL组(114例)	PCNL组(180例)	χ²/Z	P值
性别			1.618	0.203
男	78(68.4)	110(61.1)
女	36(31.6)	70(38.9)
BMI/(kg/m²)	23.88(22.39，25.61)	23.66(21.80，25.39)	-1.164	0.245
结石大小/cm	3.03(2.31，3.80)	2.82(2.40，3.30)	-1.464	0.143
结石大小构成比			1.959	0.162
≤3 cm	57(50.0)	105(58.3)
>3 cm	57(50.0)	75(41.7)
结石密度/HU	1 528(1 352，1 618)	1 291(1 075，1 426)	-7.477	< 0.001
术前尿白细胞计数/μL	67.10(24.33，205.98)	80.70(30.70，178.45)	-0.334	0.739
术前尿培养			0.116	0.734
阴性	111(97.4)	174(96.7)
阳性	3(2.6)	6(3.3)

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表 2 2组疗效指标比较例(%)，M(Q₁，Q₃)

指标	FANS-UAS联合FURL组(114例)	PCNL组(180例)	χ²/Z	P值
术后1 d SFR	81(71.1)	133(73.9)	0.283	0.594
术后1个月SFR	87(76.3)	147(81.7)	1.230	0.267
手术时间/min	105.0(75.0，136.3)	95.0(75.0，130.0)	-1.309	0.191
术中出血量/mL	10(10，10)	50(5，100)	-6.236	< 0.001
肾盂内积血	8(7.0)	4(2.2)	2.966	0.085
肾包膜下血肿	1(0.9)	7(3.9)	1.389	0.239
输血	0(0)	3(1.7)	0.624	0.430
血红蛋白下降值/(g/L)	13.0(6.0，19.0)	13.0(6.0，19.0)	-0.596	0.551
脓毒性休克	1(0.9)	5(2.8)	0.490	0.484
发热	1(0.9)	21(11.7)	11.736	< 0.001
术后血白细胞计数/(×10⁹/L)	10.26(8.09，12.82)	8.25(6.13，11.44)	-3.944	< 0.001
术后血中性粒细胞比例/%	79.10(72.68，83.63)	74.80(56.40，85.5)	-2.296	0.022
术后血清CRP/(mg/L)	3.95(1.20，13.61)	2.00(2.00，6.88)	-1.045	0.296
术后血清PCT/(ng/L)	0.020(0.020，0.033)	0.050(0.028，0.798)	-8.270	< 0.001
术后血肌酐/(μmol/L)	80.0(66.8，95.0)	77.0(62.0，97.0)	-0.684	0.494
术后VAS评分/分	2(2，2)	3(2，3)	-10.938	< 0.001
术后住院天数/d	1(1，2)	5(5，6)	-14.200	< 0.001
二期手术	11(9.6)	29(16.1)	2.479	0.115

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