可弯曲负压吸引鞘联合输尿管软镜治疗老年人上尿路结石的疗效及安全性评估

Efficacy and safety of flexible tip-bendable suction ureteral access sheath combined with flexible ureteroscopy for upper urinary tract stones in elderly patients

摘要:

目的 探讨可弯曲负压吸引鞘联合输尿管软镜治疗老年人上尿路结石的疗效及安全性。方法 回顾性分析2024年4月—2024年12月首都医科大学附属北京友谊医院泌尿外科收治的输尿管软镜碎石术老年患者的临床资料。根据术中使用的输尿管鞘类型分为可弯曲负压吸引鞘组和传统软镜鞘组，比较两组的清石率、手术时间、术后住院时间、术后并发症及输尿管损伤等情况。结果 本研究共纳入95例患者，其中可弯曲负压吸引鞘组49例，传统软镜鞘组46例。可弯曲负压吸引鞘组即刻清石率高于传统软镜鞘组（P <0.05），手术时间短于传统软镜鞘组（P <0.05），术中网篮使用率及术后支架留置率低于传统软镜鞘组（P <0.05）。两组患者术后4周清石率、住院时间、术后发热率、术后持续性肉眼血尿率、术后肾绞痛率和输尿管损伤发生率的比较，差异均无统计学意义（P >0.05）。结论 可弯曲负压吸引鞘在老年人输尿管软镜碎石术中能显著提高即刻清石率，缩短手术时间，并减少输尿管支架及取石网篮的使用，具有较高的安全性，值得临床推广。

Abstract:

Objective To investigate the efficacy and safety of flexible tip-bendable suction ureteral access sheath (S-UAS) combined with flexible ureteroscopy (fURS) in treating upper urinary tract stones in elderly patients.Methods A retrospective analysis was conducted on elderly patients undergoing fURS lithotripsy at Beijing Friendship Hospital from April to December 2024. Patients were divided into S-UAS group (n = 49) and traditional ureteral access sheath (T-UAS) group (n = 46). Stone-free rate (SFR), operative time, postoperative hospital stay, complications (fever, gross hematuria, renal colic), and ureteral injury were compared.Results The S-UAS group had higher immediate SFR (P < 0.05), shorter operative time (P < 0.05), and lower intraoperative basket usage (P < 0.05) and postoperative stent placement rates (P < 0.05). No significant differences were observed in 4-week SFR, hospital stay, postoperative fever, hematuria, renal colic, or ureteral injury (P > 0.05).Conclusion S-UAS improves immediate stone clearance, shortens operative duration, and reduces stent/basket use in elderly patients, demonstrating high safety for clinical adoption.