智能控溫控壓輸尿管軟鏡聯合負壓吸引鞘治療直徑≤2.5 cm上尿路結石的療效分析

ABSTRACT：ObjectiveTo investigate the efficacy and safety of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of upper urinary tract stones ≤2.5 cm.MethodsThe clinical data of 225 patients with ≤2.5 cm upper urinary tract stones treated with this surgical method in our department during Aug. 2023 and Jul. 2024 were retrospectively analyzed. The patients were divided into the dual-control group （n=36） and conventional group （n=189） according to whether or not the intelligent temperature and pressure control device was used during operation. In the dual-control group，the intraoperative temperature and pressure in the renal pelvis were monitored and controlled in real time by the temperature and pressure sensors distributed at the end of the ureteral soft lens. The perioperative parameters，stone-removal rate，complication rate and renal function were compared between the two groups.ResultsAll operations were successfully completed in both groups. The postoperative procalcitonin （PCT） level [（22.75±5.85） ng/L vs. （29.08±6.60） ng/L，P=0.001]，difference in the white blood cell （WBC） level [（0.24±2.12）×109cells/L vs. （1.19±2.17）×109cells/L，P=0.016]，incidence of fever （2.8% vs. 16.9%，P=0.028） and overall complication rate （5.6% vs. 19.6%，P=0.042） were significantly lower in the dual-control group than in the conventional group，while the stone-clearance rate was slightly higher （88.9% vs. 82.5%，P=0.346），with no significant difference.ConclusionFor upper urinary tract stones ≤2.5 cm，intelligent temperature-pressure-controlled ureteroscopy combined with negative-pressure suction sheath lithotripsy has a satisfactory stone-removal rate and a low rate of complications，which is worthy of clinical promotion.

摘要：目的探討智能控溫控壓輸尿管軟鏡聯合負壓吸引鞘碎石術治療直徑≤2.5 cm上尿路結石的有效性和安全性。方法回顧性分析2023年8月—2024年7月在鄭州大學第二附屬醫院泌尿外科行負壓吸引鞘聯合輸尿管軟鏡碎石術的225例直徑≤2.5 cm上尿路結石患者的臨床資料，根據術中是否使用智能控溫控壓裝置分為雙控組（36例）和常規組（189例）。其中雙控組可通過輸尿管軟鏡頭端的溫度和壓力傳感器實時監測并控制術中腎盂內的溫度及壓力。比較兩組間圍手術期出血及炎癥指標、結石清除率、并發癥發生率及腎功能等指標。結果兩組手術均順利完成，雙控組較常規組的術后降鈣素原（PCT）水平[（22.75±5.85）ng/L vs.（29.08±6.60）ng/L，P=0.001]、白細胞（WBC）差值[（0.24±2.12）×109個/L vs. （1.19±2.17） ×109個/L，P=0.016]、發熱（2.8% vs. 16.9%，P=0.028）及總并發癥發生率（5.6% vs.19.6%，P=0.042）更低，差異有統計學意義。結石清除率雙控組略高于常規組（88.9% vs.82.5%，P=0.346），但差異無統計學意義。結論對于直徑≤2.5 cm的上尿路結石，智能控溫控壓輸尿管軟鏡聯合負壓吸引鞘碎石術結石清除率滿意、術后并發癥較少，值得在臨床推廣。

關鍵詞：上尿路結石；輸尿管軟鏡；智能控溫控壓；并發癥

中圖分類號：R691.4" " " " "文獻標志碼：A" " " " " " DOI：10.3969/j.issn.1009-8291.2025.04.008

上尿路結石是泌尿系統最常見的疾病之一，我國成年人群患病率達5.6%，并且呈逐漸上升趨勢[1]。近年來，輸尿管軟鏡鈥激光碎石術（lithotripsy with flexible ureteroscope，FURL）已成為治療≤2.5 cm上尿路結石的首選方案，但術中激光產生的熱效應會增加軟組織熱損傷風險[2-3]。同時，腎盂內灌注壓升高可導致腎盂內液逆流入血，增加了尿源性膿毒血癥的發生風險[4-5]。智能控溫控壓輸尿管軟鏡的頭端置有智能控溫控壓傳感器，能夠實時監測并調控腎內溫度和壓力，從而降低手術并發癥的發生率[6]。……