输尿管通路鞘辅助输尿管镜治疗输尿管结石的临床疗效分析

Clinical effect analysis of ureteral access sheath assisted ureteroscopy in the treatment of ureteral calculi

目的比较输尿管镜碎石取石术中使用或不使用输尿管通路鞘辅助在手术效率、术后疗效及并发症方面的差异。方法我们回顾分析了2017年10月至2019年10月在中山大学附属第三医院泌尿外科进行手术治疗的92例输尿管结石患者的术前和术后资料。病例被分为有输尿管鞘组和无输尿管鞘组。统计分析了患者的基本信息、结石负荷、手术时间、术后住院时间、是否发热及术后残石率等。结果有39例(42.4%)使用输尿管通路鞘进行辅助,有鞘组患者输尿管结石负荷大于无鞘组[(107±67)mm^(2) vs(66±42)mm^(2),P=0.001],有鞘组和无鞘组每分钟治疗结石量没有差异,有鞘组1例(2.3%)术后有结石残留,无鞘组6例(11.3%)有结石残留,术中及术后并发症方面两组差异无统计学意义。在比较输尿管中上段结石时,27例(45.8%)使用输尿管通路鞘进行辅助,有鞘组每分钟治疗结石量高于无鞘组[(2.4±1.3)mm^(2)/min vs(1.7±1.0)mm^(2)/min,P=0.029。结论在治疗输尿管中上段结石时,使用输尿管通路鞘可以提高手术效率,但不增加术中与术后并发症的发生。

Objective To compare the operative efficiency,postoperative efficacy and complications of ureteroscopic lithotripsy with or without ureteral access sheath(UAS).Methods Preoperative and post-operative data of 92 patients who underwent ureteroscopic lithotripsy for ureteral calculi in The Third Affiliated Hospital of Sun Yat-sen University from October 2017 to October 2019 were analyzed retrospectively.Patients were divided into UAS group and no UAS(NUAS)group.The basic information,stone burden,operation time,hospitalization time,fever and stone-free rate were compared.Results UAS was used in 42.4%(39/92)patients.The UAS group had greater stone burden compared to the NUAS group[(107±67)mm^(2) vs(66±42)mm^(2),P=0.001].There were no differences in the amount of stone burden treated per minute in the UAS group and the NUAS group.There was 1 case(2.3%)of postoperative residual calculi in the UAS group and 6 cases(11.3%)of NUAS group with residual calculi.Intraoperative and postoperative complications in two groups had no statistical difference.In terms of calculi in the middle and upper ureteral segments,27 patients(45.8%)were treated with UAS.The amount of stone burden treated per minute was higher in the UAS group than NUAS group[(2.4±1.3)mm^(2)/min vs(1.7±1.0)mm^(2)/min,P=0.029].Conclusion In the treatment of middle and upper ureteral calculi,the use of ureteral access sheath can improve the surgical efficiency,but does not increase the risk of intraoperative and postoperative complications.