可弯曲负压吸引鞘联合一次性输尿管软镜治疗1～2 cm肾下盏结石的疗效

Efficacy of flexible ureteroscope lithotripsy with flexible vacuum-assisted urethral access sheath for 1-2 cm lower renal calyceal stones

摘要

目的 比较一次性输尿管软镜联合可弯曲负压吸引鞘（FV-UAS）及传统输尿管软镜鞘（UAS）治疗1～2 cm肾下盏结石的临床疗效与安全性，为肾下盏结石的治疗提供参考。方法 回顾性分析2021年3月-2023年10月收治的157例接受输尿管软镜碎石术治疗的1～2 cm肾下盏结石患者的资料，其中80例患者采用传统UAS（传统UAS组），77例采用FV-UAS（FV-UAS组），比较两组患者的一般资料及临床资料。结果 FV-UAS组术后即刻及最终结石清除率（SFR）均显著高于传统UAS组，差异具有统计学意义（84.4% vs.67.5%，P=0.013；88.3% vs.75.0%，P=0.032）；传统UAS组术后发热、肾绞痛、肾周血肿等并发症发生率明显高于FV-UAS组（15.0% vs.5.2%，P=0.042）。两组患者术后并发症经抗感染、止痛药物治疗后均缓解，术后均无严重脓毒血症或感染性休克发生，且FV-UAS组住院费用明显低于传统UAS组[（18 341±1519）元 vs.（19 152±1826）元，P=0.003]。结论 相比传统UAS，FV-UAS联合一次性输尿管软镜治疗1～2 cm肾下盏结石具有较高的SFR和较低的并发症发生率，患者术后痛苦较小、恢复快，且住院费用更低，为肾下盏结石提供了新的治疗选择。

Abstract

Objective To compare the clinical efficacy and safety of flexible ureteroscope lithotripsy (FURL) combined with flexible vacuum-assisted urethral access sheath (FV-UAS) and traditional UAS in the treatment of 1-2 cm lower renal calyceal stones, so as to provide reference for clinical practice. Methods Clinical data of 157 patients with 1-2 cm lower renal calyceal stones treated with FURL during Mar.2021 and Oct.2023 were retrospectively analyzed, including 80 treated with traditional UAS, and 77 with FV-UAS. General and clinical information of the two groups were compared. Results The immediate stone-free rate (SFR) (84.4% vs.67.5%, P=0.013) and final SFR (88.3% vs.75.0%, P=0.032) of the FV-UAS group were significantly higher than those of the traditional UAS group, with significant difference. The incidence of postoperative complications such as fever, renal colic, and perirenal hematoma was significantly higher in the traditional UAS group than in the FV-UAS group (15.0% vs.5.2%, P=0.042). After treatment with anti-infective and analgesic drugs, both groups were improved, and no severe sepsis or septic shock occurred after surgery. The hospitalization expenses of the FV-UAS group were significantly lower than those of the traditional UAS group [(18 341±1519) yuan vs. (19 152±1826) yuan, P=0.003]. Conclusion Compared to the traditional UAS, the combination of FURL and FV-UAS for the 1-2 cm lower renal calyceal stones has a high SFR and low incidence of complications. Patients experience less pain, recover faster and spend less. It's a new treatment option for inferior calyceal calculi.

关键词

可弯曲负压吸引鞘 / 肾下盏结石 / 输尿管软镜碎石术 / 结石清除率 / 肾盂内压

Key words

flexible vacuum-assisted ureteral access sheath / lower renal calyceal stones / flexible ureteroscope lithotripsy / stone-free rate / intrarenal pressure

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