自制测压吸石输尿管扩张鞘在输尿管软镜治疗肾结石中的应用（附33例报告）

摘要

目的：探讨自制测压吸石输尿管扩张鞘联合负压吸引器在输尿管软镜治疗肾结石术中的应用价值。方法2015年3～5月，使用自制测压吸石输尿管扩张鞘（专利号：201520062247.6）配合负压吸引装置，对33例肾结石行输尿管软镜钬激光碎石治疗。术前设定灌注泵流量0.2 L／min，灌注压力上限设定为100 mm Hg，吸引负压为10 kPa，通过自制测压吸石输尿管扩张鞘副通道监测肾内压力，使用蚕食法边碎石边吸石，尽量将结石击碎至0.2 mm，术中根据视野清晰情况及肾内压力大小对灌注流量、压力及时进行调整。结果术中初始肾内压力为（14.7±3.2） mm Hg （9～22 mm Hg），灌注时间（29.3±2.5）min（25～37 min），术中视野清晰，无肾脏出血、破裂，术后生命体征平稳，无发热、尿源性脓毒血症等并发症，出院前1天复查腹部平片提示残留结石最大直径约1 cm 9例，0.5 cm 15例，＜0.3 cm 9例，术后住院时间均为2天。术后1个月均返院取出双J管。术后2个月复查腹部平片及泌尿系B超，28例未见结石残留，5例见结石碎片残留于肾下极，直径＜0.3 cm。结论本研究初步表明，使用自制测压吸石输尿管扩张鞘，手术过程安全，正负压力、进出流量可控，吸石效果良好。%Objective To investigate the application value of a self-made pressure-measuring and stone-extracting ureteral access sheath ( UAS ) used together with vacuum suction system during flexible ureteroscopy in the treatment of renal stones. Methods By using flexible ureteroscopy with holmium laser, a self-made ureteral access sheath (Patent No.201520062247.6) and vacuum suction system were used to treat 33 cases of renal stones from March to April in 2015.The irrigation flow rate, irrigation pressure, and the suction level were set at 0.2 L/min, 100 mm Hg, and 10 kPa, respectively.While monitoring the renal pelvic pressure, the stones were fragmented to 0.2 mm and cleared out with the vacuum suction system.During the operation, the irrigation flow rate and pressure were adjusted according to visual field and renal pelvic pressure. Results The average initial pelvic pressure was 14.7 ±3.2 mm Hg (9 -22 mm Hg).The average irrigation time was 29.3 ±2.5 min (25 -37 min).There were no complications in or after operation and the vision was clear.The kidney ureter bladder ( KUB) X-ray examination rechecked one day before discharge suggested 9 patients with residual stones of 1 cm in diameter, 15 patients with residual stones of 0.5 cm in diameter, and 9 patients with residual stones less than 0.3 cm.The postoperative length of hospital stay was 2 days in all the patients.One month after the operation, all the patients underwent re-examination to remove the double-J tube.Two months after the operation, the abdominal X-ray and urinary B-ultrasound examinations showed 28 cases had no residual stones and 5 cases had stone fragments less than 0.3 cm in diameter remained in the lower calix. Conclusion Use of self-made pressure-measuring and stone-extracting UAS is safe and effective, with manageable renal pelvic pressure and irrigation flow rate and satisfactory results.