目的 在单中心回顾性队列中评估一次性输尿管软镜(FURS)联合末端可弯曲负压吸引鞘(ASS)治疗输尿管嵌顿性结石的有效性与安全性。方法 纳入2023-12至2024-12单侧嵌顿性结石患者62例,“嵌顿”为同一部位停留≥2个月且输尿管壁局限性增厚≥2 mm。所有患者接受FURS联合ASS钬激光碎石术。主要指标为术后第1天结石清除率(SFR),次要指标包括手术时间、围手术期并发症(Clavien-Dindo分级)、住院时间及3～6个月随访结果。采用单样本t检验或χ2检验将本研究数据与5篇同类研究(n=666)的汇总均值进行比较。结果 62例均一期成功置鞘,手术成功率100%。平均结石最大径为(15.4±4.2)mm,CT值为(1215±285)HU。术后第1天SFR为95.2%,围手术期并发症均为ClavienⅠ～Ⅱ级,术后平均住院为(2.6±0.9)d。随访3～6个月,SFR为100%,无输尿管狭窄或重度肾积水。与文献汇总均值相比,手术时间缩短[(58.6±12.8)min vs.(66.0±14.5)min,t=6.13,P=0.002]、SFR提高(95.2% vs. 88.5%,χ2=6.58,P=0.010)、并发症发生率降低(4.8% vs. 9.4%,χ2=4.31,P=0.038),差异均有统计学意义。结论 一次性FURS联合ASS治疗输尿管嵌顿性结石在文献对照下具显著优势,可作为嵌顿性结石的一线微创方案,但需多中心随机对照试验进一步验证远期疗效。
Abstract
Objective To evaluate the efficacy and safety of single-use flexible ureteroscopy (FURS) combined with a distal articulated suction sheath (ASS) in the treatment of impacted ureteral stones in a single-center retrospective cohort. Methods A total of 62 patients with unilateral impacted calculi from December 2023 to December 2024 were enrolled. “Impaction” was defined as stone incarceration≥2 months with focal ureteral-wall thickening≥2 mm. All patients underwent holmium laser lithotripsy via FURS with ASS. The primary outcome was stone-free rate (SFR) on post-operative day 1; secondary outcomes included operative time, perioperative complications (Clavien-Dindo classification), length of stay and 3-6 month follow-up results. One-sample t-test and χ2 test were used to compare the data with pooled means from five analogous studies (n=666). Results All 62 cases achieved primary successful sheath placement (success rate 100%). Mean stone diameter was (15.4±4.2) mm and mean CT attenuation (1215±285) HU.SFR on day 1 was 95.2%,peri-operative complications were all Clavien grade Ⅰ-Ⅱ,mean post-operative stay was (2.6±0.9) days. During the 3-6 month follow-up, the SFR was 100% and no ureteral stricture or severe hydronephrosis occurred. Compared with the pooled literature values, the operative time was shortened [(58.6±12.8) min vs. (66.0±14.5) min, t=6.13, P=0.002], the SFR increased (95.2% vs. 88.5%, χ2=6.58, P=0.010), the complication rate was reduced (4.8% vs. 9.4%, χ2=4.31, P=0.038), and all differences were statistically significant. Conclusions Single-use FURS combined with ASS in the treatment of impacted ureteral calculi offers significantly superior outcomes in literature comparisons and be used as the first-line minimally invasive treatment for impacted ureteral stones. However, further multi-center randomized controlled trials are needed to validate the long-term efficacy.
关键词
输尿管结石 /
嵌顿 /
输尿管软镜 /
可弯曲负压吸引鞘 /
钬激光
Key words
ureteral calculus /
impaction /
flexible ureteroscopy /
articulated suction sheath /
holmium laser
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