Optimizing tip-flexible ureteral access sheath parameters with intelligent pressure control in stone-clearing mode: an in vitro study
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摘要: 目的 模拟术中不同体位、灌流流速与负压吸引水平的条件组合，探讨清石过程中的最佳参数，评估智能控压软镜系统的效果。方法 分别设置灌注流速(80、100、150 mL/min)与负压吸引水平(低、中、高)，形成9种不同的清石模式，同时调整模型体位为平卧、头高脚低(15°和30°)及头低脚高(15°和30°)。每组实验测量5 min内清除的结石重量并评估不同条件对清石效率的影响。结果 单因素分析显示，体位(P < 0.001)和负压水平(P＝0.018)对结石清除有显著影响。多因素分析进一步表明，与平卧位相比，头高脚低30°显著提高了清石效率(P＝0.001)；头低脚高15°同样对结石清除具有正向作用(P＝0.035)，但头低脚高30°却显著降低了清石效率(P＝0.002)。此外，负压高档相较于中档和低档能显著提高清石效率(P < 0.001)。虽然灌流流速的单因素影响差异无统计学意义(P＝0.073)，但在与体位和负压的配合下，其作用显现出差异有统计学意义(P＝0.006)。结论 在保证肾盂内压安全的前提下，利用负压吸引结石时，可以采用头高脚低体位，并配合较高的灌流流速和较高的负压吸引水平，有助于结石的清除。Abstract: Objective To simulate the combinations of intraoperative positions, irrigation flow rates, and negative pressure suction levels to explore the optimal parameter for stone clearance and to evaluate the performance of an intelligent pressure-controlled flexible ureteroscope system.Methods Irrigation flow rates(80, 100, 150 mL/min) and negative pressure suction levels(low, medium, high) were set to form nine different stone clearance modes, while the model's positions were adjusted to supine, head-up(15°and 30°), and head-down(15°and 30°) tilt angles. The weight of stones cleared within 5 minutes was measured for each group, and the effects of different conditions on stone clearance efficiency were assessed.Results The univariate analysis showed that body position(P < 0.001) and negative pressure level(P＝0.018) had a significant impact on stone clearance. Multivariate analysis further revealed that, compared to the supine position, a 30° head-up, feet-down position significantly improved the clearance efficiency(P＝0.001); a 15° head-down, feet-up position also had a positive effect on stone clearance(P＝0.035), but a 30° head-down, feet-up position significantly reduced the clearance efficiency(P＝0.002). Additionally, a high negative pressure level significantly improved the clearance efficiency compared to the medium and low levels(P < 0.001). Although the univariate effect of perfusion flow rate was not significant(P＝0.073), its effect became statistically significant when combined with body position and negative pressure(P＝0.006).Conclusion Under the premise of ensuring the safety of renal pelvis pressure, when using negative pressure suction to remove stones, a head-up, feet-down position can be adopted, along with a higher perfusion flow rate and higher negative pressure suction level. This helps in the clearance of the stones.
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表 1 结石清石情况的单因素分析
影响因素 效应量 F P值 体位 0.886 7.801 < 0.001 灌流流速 0.772 3.378 0.073 负压 0.816 4.444 0.018 
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表 2 不同因素对结石清石情况的多因素分析
影响因素 回归系数 OR t P值 95%置信区间 下限 上限 头低脚高15° 0.121 1.128 2.183 0.035 0.009 0.233 头低脚高30° -0.124 0.883 -3.236 0.002 -0.202 -0.046 头高脚低15° 0.074 1.077 1.939 0.060 -0.003 0.152 头高脚低30° 0.132 1.141 3.433 0.001 0.054 0.210 平卧位 -0.021 0.979 -0.538 0.594 -0.098 0.057 低档vs中档 -0.018 0.982 -0.594 0.556 -0.078 0.043 高档vs中档 0.107 1.113 2.928 < 0.001 0.047 0.167 流速 0.001 1.001 2.928 0.006 < 0.001 0.002
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