Delvecchio Fernando C, Auge Brian K, Brizuela Ricardo M, Weizer Alon Z, Silverstein Ari D, Lallas Costas D, Pietrow Paul K, Albala David M, Preminger Glenn M
Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Urology. 2003 Mar;61(3):518-22; discussion 522. doi: 10.1016/s0090-4295(02)02433-0.
To analyze the long-term incidence of ureteral stricture formation in a series of patients in whom a new-generation ureteral access sheath was used. A new generation of ureteral access sheaths has been developed to facilitate ureteroscopic procedures. However, some have questioned their safety and whether the device might cause significant ureteral trauma.
Between September 1999 and July 2001, 150 consecutive ureteroscopic procedures with adjunctive use of an access sheath were performed. A retrospective chart review to April 2002 was done. Of the 150 patients, 130 underwent ureteroscopy for ureteral stones. Patients who underwent endoureterotomy or treatment of transitional cell carcinoma were excluded from this analysis. Sixty-two patients had follow-up greater than 3 months and were included in the analysis. Overall, 71 ureteroscopic procedures were performed, with 9 patients undergoing multiple procedures. Ninety-two percent of the patients had pathologic findings above the iliac vessels. The average patient age was 45.3 years (range 17 to 76), and 70% and 30% of the patients were male and female, respectively. The mean clinical follow-up was 332 days (range 95 to 821), and follow-up imaging was performed within 3 months after ureteroscopy in all patients.
The 10/12F access sheath was used in 8 ureteroscopic procedures (11.2%), the 12/14F access sheath in 56 (78.9%), and the 14/16F access sheath in 7 (9.8%). One stricture was identified on follow-up imaging of 71 procedures performed, for an incidence of 1.4%. The patient developed the stricture at the ureteropelvic junction after multiple ureteroscopic procedures to manage recurrent struvite calculi. The access sheath did not appear to be a contributing factor.
The results of our series indicate that the ureteral access sheath is safe and beneficial for routine use to facilitate flexible ureteroscopy. However, awareness of the potential ischemic effects with the use of unnecessarily large sheaths for long periods in patients at risk of ischemic injury should be considered. We advocate the routine use of the device for most flexible ureteroscopic procedures proximal to the iliac vessels.
分析一系列使用新一代输尿管通路鞘的患者中输尿管狭窄形成的长期发生率。新一代输尿管通路鞘已被研发出来以方便输尿管镜检查操作。然而，一些人对其安全性以及该装置是否可能导致严重的输尿管损伤提出了质疑。
在1999年9月至2001年7月期间，连续进行了150例输尿管镜检查并辅助使用通路鞘。对截至2002年4月的病历进行回顾性分析。150例患者中，130例因输尿管结石接受输尿管镜检查。接受输尿管内切开术或移行细胞癌治疗的患者被排除在本分析之外。62例患者随访时间超过3个月并纳入分析。总体而言，共进行了71例输尿管镜检查操作，9例患者接受了多次操作。92%的患者病变位于髂血管上方。患者平均年龄为45.3岁（范围17至76岁），男性和女性患者分别占70%和30%。平均临床随访时间为332天（范围95至821天），所有患者在输尿管镜检查后3个月内进行了随访影像学检查。
8例输尿管镜检查操作（11.2%）使用了10/12F通路鞘，56例（78.9%）使用了12/14F通路鞘，7例（9.8%）使用了14/16F通路鞘。在对71例操作进行的随访影像学检查中发现1例狭窄，发生率为1.4%。该患者在多次输尿管镜检查治疗复发性鸟粪石结石后，在输尿管肾盂连接处出现狭窄。通路鞘似乎不是一个促成因素。
我们系列研究的结果表明，输尿管通路鞘对于方便软性输尿管镜检查的常规使用是安全且有益的。然而，对于有缺血性损伤风险的患者，应考虑到长时间使用不必要的大鞘可能产生的潜在缺血影响。我们主张在大多数髂血管近端的软性输尿管镜检查操作中常规使用该装置。
