Vanlangendonck Richard, Landman Jaime
Division of Urology, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO 63110, USA.
Urol Clin North Am. 2004 Feb;31(1):71-81. doi: 10.1016/S0094-0143(03)00095-8.
Routine use of the ureteral access sheath during flexible ureteroscopic procedures provides consistent, reliable, and unencumbered access to the upper tracts. The ureteral access sheath can be reliably and easily deployed if used properly and requires no special training. As such, it can be easily adopted into current urologic practice. Not only does the access sheath facilitate rapid, repeated, and atraumatic access to the upper tracts, but it also avoids back-loading over a superstiff guidewire, which may incur costly damage to the ureteroscope. The access sheath reduces overall costs and decreases operative times. Furthermore, application of a ureteral access sheath reduces the frustration associated with complex and some routine ureteroscopic procedures by optimizing irrigant flow to improve the surgeon's endoscopic vision while minimizing the intrarenal pressures that the kidney must tolerate. There is no evidence that the access sheath results in clinically significant ureteral ischemia, and extensive clinical use of the access sheath for long procedures has not resulted in increased stricture formation. Finally, the ureteral access sheath is useful for other procedures, such as PCNL, by improving visualization and minimizing the requirement for multiple percutaneous access sites. Winston Churchill said it best: "Give us the tools and we will finish the job." Industry has provided urologists with the tools in the form of advanced flexible ureteroscopes, the holmium laser, nitinol baskets, and the ureteral access sheath. Now it is up to urologists to finish the job.
在软性输尿管镜检查过程中常规使用输尿管通路鞘，可为上尿路提供持续、可靠且不受阻碍的通路。如果使用得当，输尿管通路鞘能够可靠且轻松地置入，无需特殊培训。因此，它可轻松应用于当前的泌尿外科实践中。通路鞘不仅有助于对上尿路进行快速、反复且无创的通路建立，还能避免在超硬导丝上进行反向装载，这可能会对输尿管镜造成代价高昂的损坏。通路鞘降低了总体成本并缩短了手术时间。此外，通过优化灌流以改善术者的内镜视野，同时将肾脏必须承受的肾内压力降至最低，输尿管通路鞘的应用减少了与复杂及一些常规输尿管镜检查相关的挫败感。没有证据表明通路鞘会导致具有临床意义的输尿管缺血，并且在长时间手术中广泛临床应用通路鞘并未导致狭窄形成增加。最后，输尿管通路鞘通过改善视野并减少对多个经皮穿刺通路部位的需求，对其他手术（如经皮肾镜取石术）也很有用。温斯顿·丘吉尔说得最好：“给我们工具，我们就能完成工作。”业界已通过先进的软性输尿管镜、钬激光、镍钛合金网篮和输尿管通路鞘等形式为泌尿外科医生提供了工具。现在就看泌尿外科医生如何完成这项工作了。
