可弯曲负压鞘联合软镜治疗≤3 cm上尿路结石的临床研究

Clinical study on negative pressure flexible sheath combined with ureteroscopy for treating≤3 cm upper urinary tract stones

目的:比较可弯曲负压鞘与负压直鞘、普通直鞘联合输尿管软镜在≤3 cm上尿路结石治疗中的临床疗效与安全性。方法:回顾性分析2022年1月至2023年9月重庆医科大学附属第一医院及重庆市綦江区人民医院接受输尿管软镜钬激光碎石取石术的128例上尿路结石患者的临床资料,因使用输送鞘不同,将病例分为可弯曲负压鞘组(组1,n=61);负压直鞘组(组2,n=31);普通直鞘组(组3,n=36),普通直鞘组、负压直鞘组统称传统鞘组。比较3组患者基线数据和围手术期指标。结果:3组患者一般资料,包括:性别、年龄、体质指数(body mass index,BMI)、结石直径、结石类型及方位、术前是否留置输尿管支架、术前感染指标以及住院时间和术后血红蛋白下降值比较,差异均无统计学意义。结石直径≤3 cm,可弯曲鞘组清石率最高(91.80%vs.80.65%vs.72.22%),与普通直鞘组相比差异有统计学意义(91.80%vs.72.22%;χ^(2)=4.155,P=0.012);且其净石率最高,与传统鞘组相比差异有统计学意义(73.77%vs.41.94%vs.33.33%;χ^(2)=17.486,P<0.001)。当结石分层直径大于2 cm时,可弯曲负压鞘组比传统鞘组净石率高,差异有统计学意义(72.55%vs.36%vs.23.08%;χ^(2)=19.645,P<0.001)。当结石直径为<2 cm时,可弯曲鞘组的清石率(90.00%vs.83.33%vs.90.00%;χ^(2)=0.193,P>0.908)和净石率(80.00%vs.66.67%vs.60.00%;χ^(2)=0.963,P>0.618)较传统鞘组稍高,差异无统计学意义。可弯鞘组的手术时间更长、住院总费用更低、并发症发生率更低。结论:可弯曲负压鞘可带来更高的即刻清石率、净石率以及更低的术后感染风险,同时减少了取石网篮的使用,节约了住院费用。与传统鞘相比在治疗≤3 cm上尿路结石有更高的有效性及安全性,值得推广应用。

Objective:To compare the clinical efficacy and safety of negative pressure flexible sheath,negative pressure rigid sheath,and conventional rigid sheath combined with ureteroscopy in treating≤3 cm upper urinary tract stones.Methods:A retrospective analy-sis was performed on the clinical data of 128 patients with upper urinary tract stones who underwent ureteroscopy with holmium laser lithotripsy at The First Affiliated Hospital of Chongqing Medical University and The People’s Hospital of Qijiang District in Chongqing between January 2022 and September 2023.Based on the type of sheath used,the patients were divided into three groups:negative pressure flexible sheath(Group 1,n=61),negative pressure rigid sheath(Group 2,n=31),and conventional rigid sheath(Group 3,n=36).The conventional rigid sheath group and negative pressure rigid sheath group were collectively referred to as the traditional sheath groups.Baseline data and perioperative indicators were compared across the three groups.Results:The general information,including sex,age,body mass index,stone diameter,stone type and location,preoperative placement of ureteral stents,and preoperative infection indicators,as well as their hospitalization duration and postoperative hemoglobin decline,showed no significant differences across the three groups.For stones with diameters≤3 cm,the highest stone clearance rate was observed in the negative pressure flexible sheath group(91.80%),followed by negative pressure rigid sheath group(80.65%)and conventional rigid sheath group(72.22%).The stone clearance rate of negative pressure flexible sheath group was signifi-cantly higher than that of the conventional rigid sheath group(91.80%vs.72.22%;χ^(2)=4.155,P=0.012).Additionally,the nega-tive pressure flexible sheath group had the highest stone-free rate,which was significantly higher compared to the traditional sheath groups(73.77%vs.41.94%vs.33.33%;χ^(2)=17.486,P<0.001).When the stone diameter exceeded 2 cm,the negative pressure flexible sheath group had a significantly higher stone-free rate than the traditional sheath groups(72.55%vs.36%vs.23.08%;χ^(2)=19.645,P<0.001).For stones with diameters<2 cm,the negative pressure flexible sheath group had higher stone clearance rate(90.00%vs.83.33%vs.90.00%;χ^(2)=0.193,P>0.908)and stone-free rate(80.00%vs.66.67%vs.60.00%;χ^(2)=0.963,P>0.618)compared to the traditional sheath groups,although the differences were not significant.The negative pressure flexible sheath group had a longer surgi-cal duration,lower total hospital costs,and a lower incidence of complications.Conclusion:Negative pressure flexible sheath provides a higher immediate stone clearance rate,a higher stone-free rate,and a lower postoperative infection risk.The method also reduces the use of stone retrieval baskets and thus saves the costs.Compared to traditional sheaths,negative pressure flexible sheath demonstrates higher efficacy and safety in treating≤3 cm upper urinary tract stones and is worthy of wider application.