儿童输尿管镜嵌套导尿管直视技术在男性困难导尿中的应用研究

Application of pediatric ureteroscope-nested silicone catheter direct-vision catheterization in difficult urethral catheterization

摘要

目的 评估儿童输尿管镜嵌套硅胶导尿管直视导尿术在男性困难导尿中应用的安全性与有效性，为临床处理困难导尿提供新的微创解决方案。方法 回顾性选取2019年1月-2024年12月于首都医科大学附属北京天坛医院收治的33例常规导尿失败的成年男性患者资料作为研究对象。这些患者接受了儿童输尿管镜（F4.5/6.5）嵌套F18硅胶导尿管的直视导尿术，即将儿童输尿管镜置入导尿管腔内直至头端，利用“镜鞘效应”为导尿管提供硬性支撑和直行通道，并以三腔导尿管的独立冲洗通道连接加压冲洗，在直视下辨识尿道走向并引导置管。分析所有患者的置管成功率、操作时间、并发症发生率及术后恢复情况。结果 33例患者中医源性/创伤性尿道损伤26例，基础病理结构异常7例。32例（97.0%）患者成功置入导尿管，其中3例（9.4%）联合应用斑马导丝辅助置管，4例（12.5%）先经成人输尿管镜扩张再成功置管。1例长段尿道狭窄（狭窄长度约4 cm）改行膀胱造瘘术。所有患者的中位操作时间为12（8，18）min，术中出血量均少于10 mL。所有患者术中未发生严重并发症，留置导尿管14 d后拔管，排尿均通畅，中位最大尿流率18.2（16.5，20.4）mL/s。中位随访时间6（4，9）个月，无尿道狭窄、尿失禁等并发症发生。结论 儿童输尿管镜嵌套硅胶导尿管直视导尿术是处理男性困难导尿的安全、有效方法。

Abstract

Objective To evaluate the safety and efficacy of direct-vision catheterization using pediatric ureteroscope-nested silicone catheter in male patients with difficult urethral catheterization，so as to provide a novel minimally invasive solution for the clinical management of difficult catheterization. Methods A retrospective analysis was conducted on 33 adult male patients with failed conventional urethral catheterization admitted to our hospital during Jan.2019 and Dec.2024. Direct-vision catheterization technique using a pediatric ureteroscope（F4.5/6.5）nested within an F18 silicone catheter was employed. The ureteroscope was inserted into the catheter lumen reaching the tip，utilizing the“sheath effect” to provide rigid support and a direct pathway. Pressurized irrigation connected to the independent channel of the three-way catheter provided sufficient fluid flow to identify the urethral course and guide catheterization under direct vision. Catheterization success rate，operation time，complication rate，and postoperative recovery were observed. Results Among the 33 patients，there were 26 cases of iatrogenic/traumatic urethral injury and 7 cases of underlying pathological structural abnormalities. Successful catheter placement was achieved in 32 patients（97.0%），3（9.4%）of which required zebra guidewire assistance，and 4（12.5%）of which were successfully catheterized after adult ureteroscope dilation. One case with long-segment urethral stricture（approximately 4 cm）underwent suprapubic cystostomy. The median operation time was 12（8，18）minutes，with intraoperative blood loss less than 10 mL. No serious complications occurred during the procedure. After 14 days of catheter indwelling，patients achieved smooth voiding，median maximum flow rate was 18.2（16.5，20.4）mL/s. During the median follow-up of 6（4，9）months，no complications such as urethral stricture or urinary incontinence occurred. Conclusion Direct-vision catheterization using pediatric ureteroscope-nested silicone catheter is a safe and effective method for managing difficult urethral catheterization in male patients.

关键词

困难导尿 / 儿童输尿管镜 / 直视导尿 / 镜鞘效应 / 尿道损伤 / 微创技术

Key words

difficult catheterization / pediatric ureteroscope / direct-vision catheterization / sheath effect / urethral injury / minimally invasive technique

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基金资助

首都卫生发展科研专项基金(首发2022-2-2044)