智能控温控压输尿管软镜联合负压吸引鞘治疗直径≤2.5cm上尿路结石的疗效分析

Efficacy of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of ≤2.5 cm upper urinary tract stones

摘要

目的 探讨智能控温控压输尿管软镜联合负压吸引鞘碎石术治疗直径≤2.5 cm上尿路结石的有效性和安全性。方法 回顾性分析2023年8月-2024年7月在郑州大学第二附属医院泌尿外科行负压吸引鞘联合输尿管软镜碎石术的225例直径≤2.5 cm上尿路结石患者的临床资料，根据术中是否使用智能控温控压装置分为双控组（36例）和常规组（189例）。其中双控组可通过输尿管软镜头端的温度和压力传感器实时监测并控制术中肾盂内的温度及压力。比较两组间围手术期出血及炎症指标、结石清除率、并发症发生率及肾功能等指标。结果 两组手术均顺利完成，双控组较常规组的术后降钙素原（PCT）水平[（22.75±5.85）ng/L vs.（29.08±6.60）ng/L，P=0.001]、白细胞（WBC）差值[（0.24±2.12）×10⁹个/L vs.（1.19±2.17）×10⁹个/L，P=0.016]、发热（2.8% vs. 16.9%，P=0.028）及总并发症发生率（5.6% vs. 19.6%，P=0.042）更低，差异有统计学意义。结石清除率双控组略高于常规组（88.9% vs. 82.5%，P=0.346），但差异无统计学意义。结论 对于直径≤2.5 cm的上尿路结石，智能控温控压输尿管软镜联合负压吸引鞘碎石术结石清除率满意、术后并发症较少，值得在临床推广。

Abstract

Objective To investigate the efficacy and safety of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of upper urinary tract stones ≤2.5 cm. Methods The clinical data of 225 patients with ≤2.5 cm upper urinary tract stones treated with this surgical method in our department during Aug. 2023 and Jul. 2024 were retrospectively analyzed. The patients were divided into the dual-control group (n=36) and conventional group (n=189) according to whether or not the intelligent temperature and pressure control device was used during operation. In the dual-control group, the intraoperative temperature and pressure in the renal pelvis were monitored and controlled in real time by the temperature and pressure sensors distributed at the end of the ureteral soft lens. The perioperative parameters, stone-removal rate, complication rate and renal function were compared between the two groups. Results All operations were successfully completed in both groups. The postoperative procalcitonin (PCT) level [(22.75±5.85) ng/L vs. (29.08±6.60) ng/L, P=0.001], difference in the white blood cell (WBC) level [(0.24±2.12)×10⁹ cells/L vs. (1.19±2.17)×10⁹ cells/L, P=0.016], incidence of fever (2.8% vs. 16.9%, P=0.028) and overall complication rate (5.6% vs. 19.6%, P=0.042) were significantly lower in the dual-control group than in the conventional group, while the stone-clearance rate was slightly higher (88.9% vs. 82.5%, P=0.346), with no significant difference. Conclusion For upper urinary tract stones ≤2.5 cm, intelligent temperature-pressure-controlled ureteroscopy combined with negative-pressure suction sheath lithotripsy has a satisfactory stone-removal rate and a low rate of complications, which is worthy of clinical promotion.

关键词

上尿路结石 / 输尿管软镜 / 智能控温控压 / 并发症

Key words

upper urinary tract stone / flexible ureteroscopy / intelligent temperature and pressure control / complication

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