内镜鞘直径比对输尿管软镜钬激光碎石术时肾盂内压的影响。

The Effect of Ratio of Endoscope-Sheath Diameter on Intrapelvic Pressure During Flexible Ureteroscopic Lasertripsy.

机构信息

1 Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China.

2 Ningbo University, Ningbo, China.

出版信息

J Endourol. 2019 Feb;33(2):132-139. doi: 10.1089/end.2018.0774.

DOI:10.1089/end.2018.0774

PMID:30595058

Abstract

PURPOSE

To clarify appropriate combinations of flexible ureteroscope (FURS) and ureteral access sheath (UAS), which can maintain a low intrapelvic pressure (IPP) during FURS with lasertripsy.

METHODS

Four kinds of FURSs (Polyscope, Olympus URF-P6, Stroz Flex-X, and Olympus URF-V) and six sizes of UASs (11/13F × 36 cm, 11/13F × 46 cm, 12/14F × 36 cm, 12/14F × 46 cm, 13/15F × 36 cm, and 13/15F × 46 cm) were tested. A novel gas-liquid-pressure-control system (GLPCS) was used to maintain a stable and adjustable irrigation pressure form 50-500 cmHO. IPPs and flow rates were recorded with different combinations of FURSs and UASs by using an in vitro fresh cadaveric porcine urinary system.

RESULTS

The GLPCS can provide stable and adjustable water pressure. The ratio of outer diameter of FURSs and inner diameter of UASs (Ratio of Endoscope-Sheath Diameter-RESD) is essential to the IPP and flow rate. The highest IPP group is the combination of Olympus URS-V and 11/13F UAS with RESD of 0.87-0.88, the IPP is over 40 cmHO when irrigation pressure comes to 250 cmHO; Olympus URS-V in 12/14F UAS is at the middle group, RESD values of 0.81-0.82, IPP reaches 40 cmHO at 500 cmHO of irrigation pressure. Combinations with RESD ≤0.75 enjoy low IPPs (<13 cmHO). Polyscope with 13/15F UASs has the highest flow rate (74.3-77.7 mL/min), whereas Olympus URS-V with 11/13F UASs has the lowest flow rate (17.0-17.3 mL/min). UAS length has less effect on the IPP and flow rate.

CONCLUSIONS

To maintain a low IPP and acceptable flow rate during flexible ureteroscope lasertripsy, RESD should be kept below 0.75. UAS length has less effect on the IPP and flow rate.

摘要

目的

明确在软式输尿管镜激光碎石术中维持较低的腔内压力（IPP）的合适的输尿管镜（FURS）和输尿管导入鞘（UAS）组合。

方法

测试了四种 FURS（Polyscope、Olympus URF-P6、Stroz Flex-X 和 Olympus URF-V）和六种尺寸的 UAS（11/13F×36cm、11/13F×46cm、12/14F×36cm、12/14F×46cm、13/15F×36cm 和 13/15F×46cm）。使用新型的气液压力控制系统（GLPCS），维持 50-500cmHO 的稳定且可调节的冲洗压力。使用体外新鲜猪泌尿系记录不同 FURS 和 UAS 组合时的 IPP 和流量。

结果

GLPCS 可提供稳定且可调节的水压。输尿管镜外径与 UAS 内径的比值（内镜鞘直径比-RESD）对 IPP 和流量至关重要。IPP 最高的一组是 Olympus URS-V 和 11/13F UAS 的组合，RESD 为 0.87-0.88，当冲洗压力达到 250cmHO 时，IPP 超过 40cmHO；Olympus URS-V 在 12/14F UAS 中处于中间组，RESD 值为 0.81-0.82，当冲洗压力为 500cmHO 时，IPP 达到 40cmHO。RESD≤0.75 的组合具有较低的 IPP（<13cmHO）。Polyscope 与 13/15F UAS 结合具有最高的流量（74.3-77.7mL/min），而 Olympus URS-V 与 11/13F UAS 结合具有最低的流量（17.0-17.3mL/min）。UAS 长度对 IPP 和流量的影响较小。