输尿管软镜联合末端可弯曲负压鞘治疗长径≥1.5 cm的输尿管嵌顿性结石的临床研究

Clinical application of flexible ureteroscope combined with flexible terminal suction ureteral access sheath in treatment of impacted ureteral calculi with a diameter of ≥1.5 cm

摘要

目的 探讨输尿管软镜联合末端可弯曲负压鞘治疗长径≥1.5 cm的输尿管嵌顿性结石的有效性和安全性并总结临床经验。 方法 回顾性分析27例于2023年1月至2024年2月在广西医科大学第一附属医院泌尿外科行输尿管软镜联合末端可弯曲负压鞘治疗长径≥1.5 cm的输尿管嵌顿性结石患者的临床资料。 结果 本组病例共27例，男23例，女4例；年龄（48.4±15.4）岁；体质指数（23.7±3.2） kg/m²；输尿管结石位于左侧19例，右侧8例；结石CT值（1 097.6±268.7） HU；结石长度为（1.8±0.3） cm，宽度为（0.9±0.2） cm；结石位于输尿管上段24例，中段2例，下段1例；合并同侧肾结石5例，无肾结石22例；肾积水（4.7±1.8） cm；术前尿白细胞（-）2例，（+）13例，（++）7例，（+++）5例；25例完成软镜手术，2例术中改变手术方式；手术时间（86.7±46.4） min；住院时间（3.1±1.7） d；术前血白细胞和血红蛋白分别为（8.0±2.4）×10⁹/L和（135.1±21.4） g/L，术后第1天血白细胞和血红蛋白分别为（8.9±2.5）×10⁹/L和（135.9±17.8） g/L；术后第1天复查无结石残留22例，有结石残留5例；术后当天体温为（36.2±0.2） ℃，无尿源性脓毒血症相关临床表现。 结论 输尿管软镜联合末端可弯曲负压鞘治疗长径≥1.5 cm输尿管嵌顿性结石安全、有效，结石清除率较高，并发症发生率较低。

Abstract

Objective To investigate the safety and efficacy of flexible ureteroscope combined with flexible terminal suction ureteral access sheath in the treatment of impacted ureteral calculi with a diameter of ≥1.5 cm，and to summarize related clinical experience. Methods A retrospective analysis was performed for the clinical data of 27 patients with impacted ureteral calculi with a diameter of ≥1.5 cm who received flexible ureteroscope combined with flexible terminal suction ureteral access sheath in The First Affiliated Hospital of Guangxi Medical University from January 2023 to February 2024. Results A total of 27 patients were enrolled，among whom there were 23 male patients and 4 female patients，with a mean age of （48.4±15.4） years and a mean body mass index of （23.7±3.2） kg/m². Of all 27 patients，19 had ureteral calculi at the left side and 8 had ureteral calculi at the right side. The CT value of stones was （1097.6±268.7） HU. The mean length and width of calculi were （1.8±0.3） cm and （0.9±0.2） cm，respectively. As for the location of calculi，24 patients had upper ureteral calculi，2 had middle ureteral calculi，and 1 had lower ureteral calculi. There were 5 patients with ipsilateral renal calculi and 22 without renal calculi. The mean depth of hydronephrosis was （4.7±1.8） cm. There were 2 patients with negative preoperative urine white blood cells，13 with weakly positive（+） urine white blood cells，7 with positive（++） urine white blood cells，and 5 with strongly positive（+++） urine white blood cells. A total of 25 patients completed flexible ureteroscopy，and 2 patients changed the surgical procedure during surgery，with a mean time of operation of （86.7±46.4） minutes and a mean length of hospital stay of （3.1±1.7） days. The levels of white blood cells and hemoglobin were （8.0±2.4）×10⁹/L and （135.1±21.4） g/L，respectively，before surgery，and （8.9±2.5）×10⁹/L and （135.9±17.8） g/L，respectively，on day 1 after surgery. Reexamination on day 1 after surgery showed that 22 patients had no residual stones，while 5 had residual stones. The mean body temperature on the day after surgery was （36.2±0.2） ℃，with no clinical manifestations of urinary sepsis. Conclusion Flexible ureteroscope combined with flexible terminal suction ureteral access sheath is safe and effective in the treatment of impacted ureteral calculi with a diameter of ≥1.5 cm，with a relatively high stone clearance rate and a relatively low incidence rate of complications.

关键词

输尿管嵌顿性结石 / 输尿管软镜 / 软镜鞘

Key words

impacted ureteral calculi / flexible ureteroscope / ureteral access sheath

基金资助

国家自然科学基金资助项目(82060134)

广西卫计委自筹经费科研课题资助项目(Z2016311)