输尿管通路鞘对肾结石治疗的影响：7年期间的前瞻性比较非随机研究结果
Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period.
作者信息
Lima Ashleigh, Reeves Thomas, Geraghty Robert, Pietropaolo Amelia, Whitehurst Lily, Somani Bhaskar K
机构信息
Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD, UK.
出版信息
World J Urol. 2020 May;38(5):1329-1333. doi: 10.1007/s00345-019-02878-5. Epub 2019 Jul 24.
PURPOSE
To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period.
METHODS
The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications.
RESULTS
During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19).
CONCLUSION
The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.
目的
比较使用和不使用输尿管通路鞘（UAS）进行肾结石治疗的结果（结石清除率和并发症）。在过去十年中，UAS在全球的使用有所增加；然而，其使用的安全性和结果仍存在疑问。我们希望研究UAS在7年期间连续治疗肾结石中的作用。
方法
对2012年3月至2018年7月期间使用和不使用UAS进行肾结石软性输尿管镜检查及结石治疗（FURS）的结果进行前瞻性比较。患者分为两组：第1组使用UAS进行结石治疗，第2组不使用UAS。前瞻性收集连续患者的人口统计学、结石大小、位置和数量、术前和术后支架使用情况、手术持续时间、结石清除率（SFR）、住院时间和并发症等数据。
结果
在研究期间，338例患者接受了肾结石FURS治疗，其中203例（60%）患者使用了UAS。患者的平均年龄为56岁（范围2 - 89岁），男女比例为204:134。第1组和第2组的平均累积结石大小分别为16.5±10.8mm和11.37±8.08mm（P<0.001），结石平均数量分别为2.17±1.99和1.66±1.50（P = 0.009）。两组术前和术后支架置入率相似。第1组（54.8±25.8分钟）手术时间比第2组（41.3±22.2分钟）长（P<0.001）。第1组结石清除率（88%）略低于第2组（94%），尽管差异无统计学意义（P = 0.07）。两组均无术中并发症。第1组有8例患者出现术后并发症（7例Clavien I/II级和1例Clavien IVa级），第2组有2例患者出现术后并发症（Clavien I级）（P = 0.19）。
结论
在我们的系列研究中，使用UAS治疗肾结石是安全的，未发现术中并发症。对于大的和多发性肾结石，结石清除率良好，术后出现轻微并发症的风险较小。
Zotero 插件