可彎曲負(fù)壓吸引鞘聯(lián)合一次性輸尿管軟鏡碎石術(shù)治療2~3 cm上尿路結(jié)石的療效

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Efficacy of FURL with FV-UAS for 2-3 cm upper urinary tract stones

TANG Qinglai，WANG Dujian，LIU Fade，ZHOU Xingzhu，TAO Rongzhen

（Department of Urology，The Affiliated Jiangning Hospital with Nanjing Medical University，Nanjing 211100，China）ABSTRACT：ObjectiveTo explore the efficacy of disposable flexible ureteroscopic lithotripsy （FURL） with flexible vacuum-assisted ureteral access sheath （FV-UAS） in the treatment of 2-3 cm upper urinary tract stones，so as to provide reference for the treatment selection.MethodsClinical data of 178 patients with upper urinary tract stones who received FURL or minimally invasive percutaneous nephrolithotomy （MPCNL） at our hospital during Apr. 2022 and Oct. 2023 were retrospectively analyzed. The patients were divided into FV-UAS group （n=90，received FV-UAS combined with diaposable FURL treatment） and MPCNL group （n=88，received MPCNL）. The general information，perioperative data，and postoperative stone-free rate （SFR） of the two groups were compared.ResultsAll operations were successfully completed. The operation time was significantly longer in the FV-UAS group than in the MPCNL group [（66.5±6.7） min vs. （63.9±74） min，P=0.015]. However，the intraoperative hemoglobin reduction [（7.3±3.1）g/L vs.（11.4±5.9）g/L]，postoperative hospital stay （P<0.001） [（2.2±0.7）d vs.（5.4±1.3）d]，and visual analogue score （VAS） [（2.7±0.9）vs.（5.6±1.1）] were significantly lower in the FV-UAS group than in the MPCNL group （P<0.001）. The incidence of persistent gross hematuria was significantly higher in the MPCNL group than in the FV-UAS group （12.5% vs. 3.3%，P=0.023）. The FV-UAS group had a similar postoperative immediate （83.3%） and final SFR （95.6%） to those of the MPCNL group （89.8%，96.6%，P>005）.ConclusionThe combination of FURL with FV-UAS for 2-3 cm upper urinary tract stones has a higher SFR and a lower complication rate.Patients experience endurable pain and fast recovery，which is worth promoting and applying in clinical practice.

KEY WORDS：flexible vacuum-assisted ureteral access sheath； flexible ureteroscopic lithotripsy； minimally invasive percutaneous nephrolithotomy； upper urinary tract stones； stone-free rate； intrarenal pressure摘要：目的探討可彎曲負(fù)壓吸引鞘（FV-UAS）聯(lián)合一次性輸尿管軟鏡碎石術(shù)（FURL）治療2～3 cm上尿路結(jié)石的效果，為結(jié)石治療方式的選擇提供參考。（剩余9813字）