负压吸引工作鞘在输尿管软镜处理>2 cm肾结石的初步应用

The clinical application of negative pressure ureteral access sheath in retrograde intrarenal surgery

目的探讨负压吸引工作鞘(NPUAS)在输尿管软镜处理>2 cm肾结石的临床价值。方法回顾性分析广州医科大学附属第五医院泌尿外科2016年8月至2017年2月,应用NPUAS行输尿管软镜碎石术的25例肾结石患者的临床资料。分析手术时间、结石清除率,术后并发症发生率等数据。结果所有患者Ⅰ期均能成功置入NPUAS,并成功找到结石,完成碎石。结石直径2.0~3.0 cm,平均(2.3±0.3)cm。手术时间35~98 min,平均(64±16)min;术后平均住院时间(4.1±1.7)d。术后1个月结石清除率92.0%(23/25)。总并发症率8%(2/25)。术后发热2例,体温<38.5℃,予加强抗感染对症处理后痊愈。无大出血、输尿管石街、撕脱、穿孔等并发症发生。结论输尿管软镜联合负压吸引工作鞘治疗肾2~3 cm结石安全有效。

Objective To report the clinical application of negative pressure of ureteral access sheath(NPUAS) in retrograde intrarenal surgery(RIRS). Methods The data of 25 kidney stones cases who was treated with flexible ureteroscopic lithotripsy in the Fifth Affiliated Hospital, Guangzhou Medical University between August 2016 and February 2017 were analyzed retrospectively. The operation time, stone-free rate and complications were evaluated. Results All patients were successfully treated with RIRS in one stage. The mean stone diameter was(2.3 ±0.3) cm, range from 2 to 3 cm. The mean operative time was(64±16) min. The average postoperative hospital stay was(4.1 ±1.7) days. The stone clearance rate was 92.0%(23/25) in the postoperative period of 1 month. The overall complication rate was 8%(2/25). After the operation, 2 cases suffered fever with body temperature <38.5℃.They were recovered after antiinfection treatment. There were no serious complications such as massive haemorrhage, ureteral steinstrasse, avulsion and perforation occured. Conclusion Retrograde intrarenal surgery with NPUAS is an effective method in the treatment of moderate-size kidney stone.