电子软性输尿管镜临床使用耐久性的初步评估

Primary evaluation of the durability of digital flexible ureteroscope in clinical application

目的：初步评估电子软性输尿管镜（Olympus，URF-V）临床使用的耐久性。方法：回顾性分析2013年9月--2014年7月由同一术者使用电子软性输尿管镜对135例上尿路疾病患者进行的149次手术操作情况，记录手术总时间和辅助仪器使用的种类和时间、软镜的可视性和操作性以及维修和损坏等相关资料。结果：135例149次手术中，治疗肾结石127例次（85．2％），尿路上皮癌3例次（2．0％），上尿路狭窄4例次（2．7％）。用于诊断15例次（10．1％）。术前预置双J管127例次（85．2％），术中使用输尿管送达鞘（ureteraccesssheath，UAS）141例次（94．6％）。134例次手术（90％，127例次为碎石，4例次为狭窄内切开，3例次为表浅性尿路上皮癌切除）使用200／zm钬激光光纤；71例次（47．7％）手术使用套石篮或取石钳等工具；44例次肾下盏结石手术中采用结石移位的方法，占肾下盏结石患者的73．3％。用于治疗和诊断目的的软镜使用时间为6167min和153min，平均46和10．2min。电子软性输尿管镜的最脆弱部分是偏转系统。结论：数字技术的出现是软性输尿管镜发展的一个里程碑。由经验丰富的资深外科医生进行手术，并配合使用多种软性输尿管镜辅助仪器，可显著提高电子软性输尿管镜的使用寿命。

Objective： To primarily evaluate the durability of digital flexible ureteroscope in clinical application. Method：All the flexible ureteroscopic procedures were performed in the same hospital by a single expert urologist with Olympus URF-V from September 2013 to July 2014. Some related data were reviewed retrospectively, Intraoperative data including total time of use, number of accessory instruments use, the visuality of digital flexible ureteroscope, its operability and other repair lists were collected. Result：A total of 149 procedures were successful- ly performed in 135 patients over a period of 11 months including 127 （85.20./00） renal calculi cases, 3 （2.0%） urothelial carcinoma cases, 4 （2.7%） stricture of urinary tract cases. The rest 15 （10.1%） procedures were used for diagnosis. Pre-stent was performed in all 127 （85.2%） lithiasis cases and the ureteral access sheath was ap- plied in 141 （94.6%） cases. The 200μm holmium laser fiber was used in 134 cases （127 cases for lithotripsy, 4 cases for incision of the stricture, 3 cases for tumor ablation）. The nitinol baskets or graspers were used in 71 ca- ses. Relocation of the stone were performed in 44 cases （73.3% of the cases with lower pole stones）. The time of the using endoscope for therapeutic and diagnostic procedures were 6 167 and 153 minutes （mean 46.0 vs 10.2 minutes per procedure）. The most fragile part of the endoscope was the deflection system. Conclusion：The advent of digital technology is a milestone in the development of {lexible ureteroscopes. The URF-V can be a durable digital flexible ureteroscope when used by experienced senior surgeons and in combination with the new ureteroscopic accessories,