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目的：分析智能控压输尿管测压导引鞘及头端可弯曲输尿管导引鞘在输尿管软镜碎石中的疗效。方法：前瞻性选取2023年10月至2024年10月重庆市医科大学附属第一医院铜梁医院泌尿外科收治的122例结石直径1～3 cm的输尿管结石患者。所有患者在随机分组后接受不同的治疗方法。A组使用可测压力的输尿管软镜吸引鞘（69例），B组使用头端可弯曲负压吸引鞘（53例）。记录和比较术中相关指标（手术时间、术中出血量、损伤情况）以及术后并发症（发热、尿脓毒血症、结石残留等）。数据采用SPSS 26.0分析，进行卡方检验和t检验。结果：相较于B组，A组术中出血量较少，手术时间较短，差异有统计学意义（P<0.05）。术后，A组发热率以及尿脓毒血症指标（白细胞计数和C-反应蛋白水平）均低于B组，差异有统计学意义（P<0.05）。术后结石残留方面，A组术后24 h和3个月时的结石直径均显著小于B组，差异有统计学意义（P<0.05）。两组完全清石率和结石残留率比较差异无统计学意义（P>0.05）,A组术后6个月和12个月输尿管狭窄发生率、结石复发率均低于B组（P<0.05）。结论：可测压力的输尿管软镜吸引鞘在手术时间、出血量方面相较于头端可弯曲负压吸引鞘具有明显优势，手术过程中损伤较小，且无术后发热和尿脓毒血症，提示其在治疗1～3 cm输尿管结石中更为安全有效。
Abstract：Objective: To analyze the efficacy of the intelligent pressure-controlled ureteral manometry access sheath and the tip-flexible ureteral access sheath in flexible ureteroscopic lithotripsy. Methods: A prospective study was conducted on 122 patients with ureteral calculi(calculus diameter: 1-3 cm) admitted to the Department of Urology, Tongliang Hospital of the First Affiliated Hospital of Chongqing Medical University, from October 2023 to October 2024. All patients were randomly divided into two groups and received different treatments: Group A(69 cases) used a pressure-measurable flexible ureteroscopic suction sheath, and Group B(53 cases) used a tip-flexible negative-pressure suction sheath. Intraoperative indicators(operation time, intraoperative blood loss, injury status) and postoperative complications(fever, urosepsis, residual calculi, etc.) were recorded and compared. Data were analyzed using SPSS 26.0, with chi-square test and t-test applied for statistical analysis. Results: Compared with Group B, Group A had less intraoperative blood loss and shorter operation time, with statistically significant differences(P<0.05). Postoperatively, the fever rate and urosepsis-related indicators(white blood cell count and C-reactive protein level) in Group A were lower than those in Group B, with statistically significant differences(P<0.05). Regarding postoperative residual calculi, the calculus diameter in Group A at 24 hours and 3 months after surgery was significantly smaller than that in Group B, with statistically significant differences(P<0.05). There were no statistically significant differences in the complete stone clearance rate and residual stone rate between the two groups(P>0.05). The incidence of ureteral stricture and calculus recurrence in Group A at 6 and 12 months after surgery was lower than that in Group B(P<0.05). Conclusion: Compared with the tip-flexible negative-pressure suction sheath, the pressure-measurable flexible ureteroscopic suction sheath has obvious advantages in operation time and blood loss, causes less injury during surgery, and is free from postoperative fever and urosepsis. These findings suggest that it is safer and more effective in the treatment of 1–3 cm ureteral calculi.
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基本信息:
DOI：10.19558/j.cnki.10-1020/r.2025.04.007
中图分类号:R699.4
引用信息:
[1]龚毅,杨峰.智能控压输尿管测压导引鞘及头端可弯曲输尿管导引鞘在输尿管软镜碎石中的疗效分析[J].微创泌尿外科杂志,2025,14(04):250-255.DOI:10.19558/j.cnki.10-1020/r.2025.04.007.