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目的探讨自制测压吸石输尿管扩张鞘联合负压吸引器在输尿管软镜治疗肾结石术中的应用价值。方法2015年3~5月,使用自制测压吸石输尿管扩张鞘(专利号:201520062247.6)配合负压吸引装置,对33例肾结石行输尿管软镜钬激光碎石治疗。术前设定灌注泵流量0.2 L/min,灌注压力上限设定为100 mm Hg,吸引负压为10 k Pa,通过自制测压吸石输尿管扩张鞘副通道监测肾内压力,使用蚕食法边碎石边吸石,尽量将结石击碎至0.2 mm,术中根据视野清晰情况及肾内压力大小对灌注流量、压力及时进行调整。结果术中初始肾内压力为(14.7±3.2)mm Hg(9~22 mm Hg),灌注时间(29.3±2.5)min(25~37 min),术中视野清晰,无肾脏出血、破裂,术后生命体征平稳,无发热、尿源性脓毒血症等并发症,出院前1天复查腹部平片提示残留结石最大直径约1 cm 9例,0.5 cm 15例,<0.3 cm 9例,术后住院时间均为2天。术后1个月均返院取出双J管。术后2个月复查腹部平片及泌尿系B超,28例未见结石残留,5例见结石碎片残留于肾下极,直径<0.3 cm。结论本研究初步表明,使用自制测压吸石输尿管扩张鞘,手术过程安全,正负压力、进出流量可控,吸石效果良好。
Objective To explore the value of self-made aspiration-aspirated ureteral dilatation combined with negative pressure suction in the treatment of renal calculus by ureteroscopy. Methods From March to May 2015, 33 cases of renal calculi underwent ureteroscopic holmium laser lithotripsy with self-made aspiration pressure ureteral dilatation sheath (Patent No .: 201520062247.6) and negative pressure suction device. Preoperative perfusion pump set 0.2 L / min, the upper limit of perfusion pressure was set to 100 mm Hg, negative suction pressure of 10 k Pa, self-made aspiration urinary dilatation catheter to monitor renal side pressure channel, use of nibbling Shoulder stone gravel, try to break the stones to 0.2 mm, intraoperative clear vision of the situation and the size of the renal perfusion flow, pressure and timely adjustments. Results Intraoperative initial renal pressure was (14.7 ± 3.2) mm Hg (9-22 mm Hg) and perfusion time was (29.3 ± 2.5) min (25-37 min). The intraoperative visual field was clear and no renal bleeding and rupture occurred. After the vital signs were stable, no fever, urinary sepsis and other complications, one day before discharge, plain film examination showed that the maximum diameter of residual stones was about 1 cm in 9 cases, 0.5 cm in 15 cases, <0.3 cm in 9 cases After hospitalization for 2 days. 1 month after surgery were returned to the hospital double J tube. Two months after operation, the abdominal plain film and urinary system B ultrasound were reviewed. Twenty-eight cases showed no residual stones. Five cases showed residual fragments of kidney stones in the lower pole of kidney, and the diameter was less than 0.3 cm. Conclusion The preliminary study shows that the use of self-made aspiration ureteral dilatation sheath, surgical safety, positive and negative pressure, out of the flow control, suction effect is good.