Abstract：Objective:To investigate the success rate and influencing factors of successful insertion of ureteral access sheath (UAS) with diameter F14 and find out the predictive factors of successful insertion of UAS during flexible ureteroscope. Methods:1 047 patients with renal stones treated by flexible ureteroscopic holmium laser lithotripsy in the second ward of our hospital in recent three years were analyzed retrospectively. The patients with successful insertion onf UAS during operation served as the experimental group, and those with no successful insertion of UAS during operation as the control group. Factors such as age, sex, BMI, stone size, stone location, isolated kidney, a history of previous ureteroscope and presetting double-J stent were analyzed. Results:There were 945 patients in the experimental group and 102 patients in the control group. The total success rate of UAS insertion was 90.3%. 473 patients (45.2%) with double-J stent presetted and the success rate of UAS insertion was 99.4%. 574 patients underwent direct operation without presetting double-J stent and the success rate of UAS insertion was 82.8%. There was no significant difference in BMI, stone size and stone position between the two groups (P>0.05). There were significant differences in age, sex, a history of previous ureteroscope, isolated kidney and presetting double J stent (P<0.05). Logistic multivariate analysis showed that presetting double J stent and a history of previous ureteroscope were correlation predictors. The success rate of UAS insertion was increased by 32.7 times when presetting double J stent before operation. The success rate of UAS insertion was increased by 11.4 times when patients had a history of previous ureteroscope. Conclusions:The success rate of UAS insertion is higher when presetting double J stent and the patients have a history of previous ureteroscope during flexible ureteroscope.
[1] 中国泌尿系结石联盟.软性输尿管镜术中国专家共识:中华医学会泌尿外科分会.中华泌尿外科杂志,2016,37(8):561-565. [2] Vanlangendonck R, Landman J.Ureteral access strategies: pro-access sheath. Urol Clin North Am, 2004,31(1):71-81. [3] 杨嗣星,郑府,柯芹,等.软性输尿管镜碎石术中肾盂内压力监测方法及意义.中华泌尿外科杂志,2014,35(8):575-578. [4] 黄建生,房杰群,肖克峰.输尿管软镜手术中放置输尿管通道鞘引起输尿管壁损伤的研究分析.国际泌尿系统杂志,2017,37(5):732-735. [5] Lildal SK, Norregaard R, Andreassen KH, et al.Ureteral access sheath influence on the ureteral wall evaluated by cyclooxygenase-2 and tumor necrosis factor-alpha in a porcine model. J Endourol, 2017,31(3):307-313. [6] Mogilevkin Y, Sofer M, Margel D, et al.Predicting an effective ureteral access sheath insertion: a bicenter prospective study. J Endourol, 2014,28(12):1414-1417. [7] Giusti G, Proietti S, Villa L, et al.Current standard technique for modern flexible ureteroscopy: Tips and tricks. Eur Urol, 2016,70(1):188-194. [8] 杨华伟,唐汇龙,李湘斌,等.输尿管软镜导入鞘置鞘困难28例临床分析.现代泌尿外科杂志,2016,21(12):936-938. [9] 蒋立量,杨嗣星.输尿管通达鞘及其临床应用.微创泌尿外科杂志,2017,6(2):124-128. [10] 席启林,王俊杰,王子贤,等.输尿管扩张鞘在输尿管软镜治疗1~2cm肾结石中的应用价值.华中科技大学学报(医学版),2017,46(6):697-699. [11] 王宽,王朝明.输尿管硬镜经输尿管软镜导入鞘联合钬激光治疗输尿管特大体积结石40例报告.现代泌尿外科杂志,2017,22(5):399-400. [12] Lamb AD, Vowler SL, Johnston R, et al.Meta-analysis showing the beneficial effect of alpha-blockers on ureteric stent discomfort. BJU Int, 2011,108(11):1894-1902. [13] Traxer O, Thomas A.Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol, 2013,189(2):580-584.
