一种新型的可智能控制肾盂压力的柔性输尿管镜：93例初步经验

A Novel Flexible Ureteroscopy with Intelligent Control of Renal Pelvic Pressure: An Initial Experience of 93 Cases.

作者信息

Deng Xiaolin, Song Leming, Xie Donghua, Fan Difu, Zhu Lunfeng, Yao Lei, Wang Xiaolin, Liu Shaohua, Zhang Yonghua, Liao Xiaohui, Liu Shengfeng, Peng Zuofeng, Hu Min, Zhu Xianxin, Huang Jianrong, Liu Tairong, Du Chuance, Guo Shulin, Yang Zhongsheng, Peng Guanghua, Ye Zhangqun

机构信息

1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .

2 Department of Urology, The Chinese Traditional Medicine Hospital of Pinghu City , Ping Hu, China .

出版信息

J Endourol. 2016 Oct;30(10):1067-1072. doi: 10.1089/end.2015.0770. Epub 2016 Sep 28.

DOI:10.1089/end.2015.0770

PMID:27558001

Abstract

BACKGROUND

Flexible ureteroscopic lithotripsy (URS) is rapidly becoming a first-line therapy for patients with renal and ureteral calculi. Most current medical infusion devices can only monitor infusion flow and pressure, but not renal pelvic pressure (RPP).

PATIENTS AND METHODS

We designed a patented intelligent system to facilitate flexible URS that included an irrigation and suctioning platform and a ureteral access sheath (UAS) with a pressure-sensitive tip, enabling regulation of the infusion flow precisely and control of the vacuum suctioning by computerized real-time recording and monitoring of RPP. A stable RPP was ensured by pressure feedback technology. Ninety-three patients with renal or ureteral calculi participated in the study and received flexible URS. Gravel particles were sucked out automatically during the flexible URS. Patients were evaluated on postoperative days 1 and 30 by X-ray of kidneys, ureters, and bladder to assess stone-free status.

RESULTS

In 81 of the 93 patients, only one surgery was needed to remove the stone. There were nine cases who failed the first surgery due to difficulty in placing the UAS, but flexible URS was performed in these patients after indwelling a Double-J stent to the ureter with the calculus for 2 weeks. Three cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. For the 90 patients who underwent flexible URS, the actual RPP was controlled under 20 mmHg with clear operative visualization. The stone-free rates at postoperative days 1 and 30 were 90.0% (81/90) and 95.6% (86/90), respectively. Clavien I complications were noted in 13 cases, while Clavien II complications were noted in two cases. No major complications (Clavien III-V) were noted.

CONCLUSIONS

Our patented system is technically feasible, safe, and efficient for treating upper urinary calculi. The advantages include breaking stones effectively and low complication rates because of its automatic control of RPP.

摘要

背景

软性输尿管镜碎石术（URS）正迅速成为肾和输尿管结石患者的一线治疗方法。目前大多数医用灌注设备只能监测灌注流量和压力，而无法监测肾盂压力（RPP）。

患者与方法

我们设计了一种获得专利的智能系统以辅助软性URS，该系统包括一个冲洗吸引平台和一个带有压力感应尖端的输尿管鞘（UAS），能够精确调节灌注流量，并通过计算机实时记录和监测RPP来控制真空吸引。通过压力反馈技术确保稳定的RPP。93例肾或输尿管结石患者参与了本研究并接受了软性URS。在软性URS过程中自动吸出碎石颗粒。术后第1天和第30天通过肾脏、输尿管和膀胱的X线检查对患者进行评估，以评估结石清除情况。

结果

93例患者中，81例仅需一次手术即可清除结石。有9例患者因放置UAS困难首次手术失败，但在将双J支架置入有结石的输尿管2周后对这些患者进行了软性URS。3例因输尿管严重狭窄改行经皮肾镜取石术。对于接受软性URS的90例患者，实际RPP控制在20 mmHg以下，手术视野清晰。术后第1天和第30天的结石清除率分别为90.0%（81/90）和95.6%（86/90）。13例出现Clavien I级并发症，2例出现Clavien II级并发症。未发现严重并发症（Clavien III - V级）。