A Novel Flexible Ureteroscopy with Intelligent Control of Renal Pelvic Pressure: An Initial Experience of 93 Cases
A Novel Flexible Ureteroscopy with Intelligent Control of Renal Pelvic Pressure: An Initial Experience of 93 Cases
复制标题
DOI：
10.1089/end.2015.0770
复制
发表时间：
2016-10-01
影响因子：
2.7
通讯作者：
Ye, Zhangqun
中科院分区：
文献类型：
--
作者：
Deng, Xiaolin;Song, Leming;Ye, Zhangqun
背景：输尿管软镜碎石术（URS）正迅速成为肾结石和输尿管结石患者的一线治疗方法。目前大多数医用输液设备只能监测输液流量和压力，而不能监测肾盂压力（RPP）。患者和方法：我们设计了一个获得专利的智能系统，以促进灵活的URS，包括一个冲洗和吸引平台和一个输尿管通路鞘（UAS）与压力敏感头，能够精确调节输液流量和控制真空吸引通过计算机实时记录和监测的RPP。采用压力反馈技术，保证了RPP的稳定。93例肾结石或输尿管结石患者参加了研究，并接受了灵活的URS。碎石颗粒在柔性URS期间被自动吸出。在术后第1天和第30天通过肾脏、输尿管和膀胱的X线检查对患者进行评价，以评估无结石状态。结果：93例患者中81例仅需一次手术即可取石。有9例患者因放置UAS困难而首次手术失败，但这些患者在输尿管结石留置双J管2周后进行了灵活的URS。3例因输尿管明显狭窄中转经皮肾镜取石术。对于接受柔性URS的90例患者，实际RPP控制在20 mmHg以下，具有清晰的手术可视化。术后第1天和第30天结石排净率分别为90.0%（81/90）和95.6%（86/90）。Clavien I并发症13例，Clavien II并发症2例。未观察到严重并发症（Clavien III-V）。结论：我们的专利系统是技术上可行的，安全，有效的治疗上尿路结石。其优点包括有效地破碎结石和低并发症发生率，因为它的自动控制的RPP。
Background: Flexible ureteroscopic lithotripsy (URS) is rapidly becoming a first-line therapy for patients with renal and ureteral calculi. Most current medical infusion devices can only monitor infusion flow and pressure, but not renal pelvic pressure (RPP). Patients and Methods: We designed a patented intelligent system to facilitate flexible URS that included an irrigation and suctioning platform and a ureteral access sheath (UAS) with a pressure-sensitive tip, enabling regulation of the infusion flow precisely and control of the vacuum suctioning by computerized real-time recording and monitoring of RPP. A stable RPP was ensured by pressure feedback technology. Ninety-three patients with renal or ureteral calculi participated in the study and received flexible URS. Gravel particles were sucked out automatically during the flexible URS. Patients were evaluated on postoperative days 1 and 30 by X-ray of kidneys, ureters, and bladder to assess stone-free status. Results: In 81 of the 93 patients, only one surgery was needed to remove the stone. There were nine cases who failed the first surgery due to difficulty in placing the UAS, but flexible URS was performed in these patients after indwelling a Double-J stent to the ureter with the calculus for 2 weeks. Three cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. For the 90 patients who underwent flexible URS, the actual RPP was controlled under 20mmHg with clear operative visualization. The stone-free rates at postoperative days 1 and 30 were 90.0% (81/90) and 95.6% (86/90), respectively. Clavien I complications were noted in 13 cases, while Clavien II complications were noted in two cases. No major complications (Clavien III-V) were noted. Conclusions: Our patented system is technically feasible, safe, and efficient for treating upper urinary calculi. The advantages include breaking stones effectively and low complication rates because of its automatic control of RPP.