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一种新型且创伤较小的肾脏穿刺针:研发及临床前研究结果

A Novel and Less Traumatic Needle for Kidney Puncture: Development and Preclinical Study Results.

作者信息

Morozov Andrey, Kalinin Nikita, Androsov Alexander, Gazimiev Artur, Lerner Yulia, Gomez Rivas Juan, Somani Bhaskar, Enikeev Dmitry, Gazimiev Magomed

机构信息

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Institute for Clinical Medicine, Sechenov University, Moscow, Russia.

出版信息

J Endourol. 2023 Jan;37(1):93-98. doi: 10.1089/end.2022.0371. Epub 2022 Nov 21.

Abstract

A considerable proportion of percutaneous nephrolithotomy complications occurs during renal puncture. An option to decrease the complications rate is needle modification to make the procedure less traumatic. We aimed to evaluate the effectiveness of the novel MG needle in a preclinical study. We developed an original MG needle based on the Veress needle concept containing an atraumatic (blunt) mandrin connected through a spring to the cannula. The MG needle's properties were compared with those of the conventional Chiba and Trocar needles in two experiments. In the first experiment, we assessed the force required to puncture the model. In the second experiment, we punctured a porcine kidney and analyzed histology report after the puncture. We performed a series of 30 punctures of polypropylene block by each needle. The force required to make a puncture with the Chiba needle (6.53 ± 0.87 N) was significantly lower compared with the MG needle (7.1 ± 1.07 N),  = 0.027. However, the MG needle turned out to be superior to the Trocar needle (8.71 ± 1.08 N),  = 0.001. A total of 15 specimens were obtained after three renal punctures were made with each needle. A microscopy of the specimen after puncture with the Chiba and Trocar needles showed small fragments of epithelium and erythrocytes inside the canal with uneven margins where the needle passed. A microscopy of the specimen after puncture with a novel MG needle showed a canal with even margins. No tissue fragments inside the canal were observed. The force required to puncture with the novel MG needle is comparable with conventional needles. According to preclinical experiments, histology report of porcine kidney indicates that renal puncture with an MG needle is less traumatic. It may reduce the risk of bleeding, and this should be proved during clinical trials.

摘要

相当一部分经皮肾镜取石术并发症发生在肾穿刺过程中。降低并发症发生率的一个方法是对穿刺针进行改进,使操作的创伤性更小。我们旨在通过一项临床前研究评估新型MG针的有效性。我们基于韦雷氏针的概念开发了一种原创的MG针,其包含一个通过弹簧与套管相连的无创伤(钝头)芯杆。在两项实验中,将MG针的特性与传统千叶针和套管针的特性进行了比较。在第一个实验中,我们评估了穿刺模型所需的力。在第二个实验中,我们对猪肾进行穿刺,并在穿刺后分析组织学报告。我们用每种针进行了一系列30次聚丙烯块穿刺。与MG针(7.1±1.07 N)相比,使用千叶针穿刺所需的力(6.53±±0.87 N)显著更低,P = 0.027。然而,结果表明MG针优于套管针(8.71±1.08 N),P = 0.001。每种针进行三次肾穿刺后共获得15个标本。用千叶针和套管针穿刺后的标本显微镜检查显示,在针穿过的通道内有上皮和红细胞的小碎片,边缘不均匀。用新型MG针穿刺后的标本显微镜检查显示通道边缘均匀。通道内未观察到组织碎片。新型MG针穿刺所需的力与传统针相当。根据临床前实验,猪肾的组织学报告表明,用MG针进行肾穿刺创伤性更小。它可能会降低出血风险,这一点应在临床试验中得到证实。

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