Clinical experience of ureteroscopic lithotripsy combined with a flexible and navigable suction ureteral access sheath for the treatment of > 2 cm renal stones
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摘要: 目的 分析并总结输尿管软镜联合末端可弯曲负压吸引鞘治疗＞2 cm肾结石的临床疗效及手术安全性。方法 回顾性分析2024年1月—2024年12月于武汉京都结石泌尿外科医院行输尿管软镜联合末端可弯曲负压吸引鞘碎石的患者，其中大负荷肾结石患者77例。纳入患者性别、年龄、基础疾病、结石最大径、结石CT值、结石部位、碎石时间、术后血尿常规、术后并发症如发热等、一期清石率及围术期指标进行总结及相关性分析。结果 手术均顺利完成，未出现严重的术后并发症。大负荷结石直径平均值(3.9±1.4) cm，平均碎石时间(63.8±23.1) min，一期清石率为75.3%，二期清石率为100%。术后发热5例(6.5%)，平均体温(37.46±0.12)℃；术后血白细胞异常者10例(13.0%)，白细胞平均值(11.6±1.4)×109个；术后尿常规异常者8例(10.4%)。结石最大径被证明是影响手术中碎石时间的主要因素，结石CT值并未显示出对碎石时间的显著影响。术后出现发热、血尿常规的患者共21例，经抗感染治疗后均痊愈，且并发症的出现与患者年龄、结石大小均无相关性。结石的位置也未显示出对碎石时间的显著影响。结论 输尿管软镜联合末端可弯曲负压吸引鞘治疗大负荷肾结石的效果良好，碎石时间较短，一期清石率高，安全可靠。
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关键词:
- 肾结石 /
- 输尿管软镜 /
- 末端可弯曲负压吸引鞘 /
- 治疗
Abstract: Objective To investigate the efficacy and safety of flexible ureteroscope combined with flexible and navigable suction ureteral access sheath in the treatment of > 2 cm renal stones.Methods From January 2024 to December 2024, a total of 77 patients who underwent lithotripsy under flexible ureteroscope combined with flexible terminal negative pressure suction sheath in Wuhan Jingdu Urolithiasis Urology Hospital were retrospectively analyzed. The gender, age, basic diseases, maximum diameter of the stone, CT value of the stone, stone location, lithotripsy time, postoperative blood and urine routine, postoperative fever and one-stage stone clearance were recorded. The above stone related indicators and perioperative indicators were summarized and analyzed.Results All operations were successfully completed without serious postoperative complications. The average maximum stone diameter was (3.9±1.4) cm, and the average lithotripsy time was (63.8±23.1) min. The stone free rate of the first stage was 75.3%, and the stone free rate of the second stage was 100%. Five patients (6.5%) had postoperative fever, and their average body temperature was (37.46±0.12)℃. Ten patients (13.0%) had abnormal blood routine after operation, and their average number of white blood cells was (11.6±1.4)×109. Eight cases (10.4%) had abnormal urine routine after operation. The maximum diameter of the stone was proved to be the main factor affecting the lithotripsy time, but the CT value of the stone did not show significant effect on the lithotripsy time. A total of 23 patients with postoperative fever, abnormal blood or urine routine were cured after anti-infection treatment. There was no correlation between the occurrence of complications and the age of the patients or the size of the stone. The location of stone presence also did not show a significant effect on lithotripsy time.Conclusion Flexible ureteroscope combined with flexible negative pressure suction sheath is effective in the treatment of > 2 cm renal stones with short lithotripsy time and high stone-free rate, so it's safe and reliable. -
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