输尿管通道鞘置入成功率影响因素的研究进展

Factors Affecting the Success Rate of Ureteral Access Sheath Placement: A Systematic Review and Future Perspectives

摘要: 背景与目的：随着泌尿外科腔镜技术的飞速发展，输尿管通道鞘(UAS)已成为逆行肾内手术(RIRS)中不可或缺的辅助装置。其主要功能在于建立从尿道外口至肾盂的连续通道，从而降低肾盂内压、改善术野可视度并提高结石清除效率。然而，在临床实际操作中，UAS置入失败的发生率依然不容忽视，且常伴随输尿管穿孔、撕裂甚至断裂等严重医源性损伤。因此，深入探究影响UAS置入成功的潜在因素，对于优化围手术期管理、降低手术风险具有重要的临床价值。方法：本文对近年来关于UAS置入安全性及成功率的国内外文献进行了系统性梳理，从患者个体特征、解剖病理学基础、术前预处理策略及术中操作技术四个维度进行了综合分析。结果：研究显示，患者年龄、性别、BMI等生理特征，输尿管管径、走行角度及顺应性等解剖因素，以及术前是否预置支架管、药物干预等准备措施，均与UAS的置入结局密切相关。此外，置入力度的控制与新型器械的应用也是决定手术成败的关键。结论：UAS置入是一个涉及多因素的复杂过程。通过术前精准的影像学评估识别高危因素，并制定个体化的预处理方案，是提高置入成功率、减少并发症的核心策略。未来研究应致力于开发基于人工智能的预测模型及具备力反馈功能的智能置入装置。

Abstract: Background: The Ureteral Access Sheath (UAS) has evolved into a standard ancillary tool in modern Retrograde Intrarenal Surgery (RIRS). It functions to establish a stable conduit from the urethral meatus to the renal pelvis, thereby reducing intrarenal pressure, improving visualization, and facilitating efficient stone fragment retrieval. However, failure in UAS placement remains a clinical challenge, often associated with severe iatrogenic injuries ranging from mucosal tears to ureteral avulsion. Consequently, a comprehensive investigation into the factors influencing placement success is critical for optimizing perioperative management and mitigating surgical risks. Methods: This article presents a systematic review of recent literature concerning the safety and efficacy of UAS placement. We critically analyzed factors across four dimensions: patient demographics, anatomical and pathological characteristics, preoperative intervention strategies, and intraoperative techniques. Results: Evidence suggests that patient physiological traits (age, gender, BMI), anatomical factors (ureteral diameter, angulation, compliance), and preparatory measures (pre-stenting, pharmacotherapy) are intimately linked to UAS placement outcomes. Furthermore, the control of insertion force and the utilization of novel device technologies play pivotal roles. Conclusion: Successful UAS placement is multifactorial. Preoperative identification of high-risk factors via precise imaging, coupled with individualized pretreatment protocols, constitutes the core strategy for enhancing success rates and minimizing complications. Future research should focus on developing AI-based predictive models and intelligent insertion devices with force-feedback mechanisms.