术前预置输尿管支架在局麻下输尿管软镜碎石取石术的疗效评估
Evaluation of the Efficacy of Preoperative Ureteral Stent Placement under Local Anesthesia in Flexible Ureteroscopic Lithotripsy
DOI: 10.12677/jcpm.2026.52175, PDF,   
作者: 冉悦力, 但丽凤, 赵泽苍, 赵 林, 尹志康*：重庆医科大学附属第一医院泌尿外科，重庆
关键词: 局部麻醉；尿路结石；输尿管支架管；Local Anesthesia； Urinary Tract Stone； Ureteral Stent
摘要: 比较局部麻醉下行输尿管软镜碎石取石术(FURS)术前预置输尿管支架与不预置输尿管支架的临床疗效。方法：选取2022年至2024年重庆医科大学附属第一医院收治的诊断为尿路结石并顺利接受局部麻醉下行FURS的病人例。根据术前准备不同分为预置输尿管支架组(简称预置组)与未预置输尿管支架组(简称未预置组)。比较两组结石清除率、术中疼痛视觉模拟量表评分(VAS)、术后疼痛视觉模拟量表评分(VAS)、术后并发症、术前尿常规及尿培养、手术前后肌酐(Scr)、白细胞计数(WBC)、中性粒细胞(NEUT)等变化情况等指标。结果：本研究表明，术前预置输尿管支架的FURS术中(P = 0.023)及术后的疼痛(P = 0.022)均低于未预置输尿管支架组，预置输尿管支架的男性群体中术后腰痛的发生率更低，女性群体术后血尿发生率更低。FURS术前预置输尿管支架有助于提高局麻手术的体验感，更好地推广局麻下输尿管软镜碎石取石术。
Abstract: To compare the clinical efficacy of preoperative ureteral stents with ureteral stents preimplanted and no ureteral stents under local anesthesia for ureteroscopic lithotripsy (FURS). Methods: From 2022 to 2024, patients diagnosed with urinary tract stones admitted to the First Affiliated Hospital of Chongqing Medical University and successfully underwent FURS under local anesthesia were selected. According to the different preoperative preparations, they were divided into preset ureteral stent group (referred to as preset group) and non-preset ureteral stent group (referred to as non-preset group). The two groups were compared to the two groups in terms of stone clearance, intraoperative pain visual analogue scale score (VAS), postoperative pain visual analogue scale score (VAS), postoperative complications, preoperative urine routine and urine culture, creatinine (Scr), white blood cell count (WBC), neutrophil (NEUT) and other changes before and after surgery. Outcome: Compared with no preoperative ureteral stenting, flexible ureteroscopic lithotripsy (FURS) with preoperative ureteral stenting is associated with milder intraoperative and postoperative pain, and is thus more acceptable to patients. Furthermore, preoperative ureteral stenting correlates with a lower incidence of postoperative low back pain in male patients and a lower incidence of postoperative hematuria in female patients. Preoperative ureteral stenting before FURS helps improve the experience of local anesthesia and facilitates the popularization of FURS under local anesthesia.
文章引用：冉悦力, 但丽凤, 赵泽苍, 赵林, 尹志康. 术前预置输尿管支架在局麻下输尿管软镜碎石取石术的疗效评估[J]. 临床个性化医学, 2026, 5(2): 716-724. https://doi.org/10.12677/jcpm.2026.52175

参考文献

[1] 王森茂, 梁培育, 王枫霞. 肾结石研究进展[J]. 河北医药, 2024, 46(13): 2032-2036+2042.
[2] 姚俊杰, 王宁, 刘慧倩, 等. 输尿管软镜治疗上尿路结石的应用研究进展[J]. 系统医学, 2024, 9(5): 195-198.
[3] He, M., Dong, Y., Cai, W., Cai, J., Xie, Y., Yu, M., et al. (2024) Recent Advances in the Treatment of Renal Stones Using Flexible Ureteroscopys. International Journal of Surgery, 110, 4320-4328. [Google Scholar] [CrossRef] [PubMed]
[4] Huang, J. and Zhang, X. (2022) Guidelines for the Diagnosis and Treatment of Chinese Urology and Andrology Diseases. Science Press, 413-456.
[5] Lingeman, J.E., McAteer, J.A., Gnessin, E. and Evan, A.P. (2009) Shock Wave Lithotripsy: Advances in Technology and Technique. Nature Reviews Urology, 6, 660-670. [Google Scholar] [CrossRef] [PubMed]
[6] 李俊谕, 余永晟, 徐金戈, 等. 对比输尿管软镜与经皮肾镜治疗直径大于2 cm非鹿角形肾结石的疗效及安全性[J]. 广州医科大学学报, 2023, 51(5): 20-23.
[7] Yu, S., Liu, L., Li, Y., Zhou, L., Chen, J., Li, H., et al. (2024) Flexible Ureteroscopic Treatment of Kidney Stones: How Do the New Laser Systems Change Our Concepts? Asian Journal of Urology, 11, 156-168. [Google Scholar] [CrossRef] [PubMed]
[8] Chen, H., Qiu, X., Du, C., Xie, D., Liu, T., Wang, G., et al. (2019) The Comparison Study of Flexible Ureteroscopic Suctioning Lithotripsy with Intelligent Pressure Control versus Minimally Invasive Percutaneous Suctioning Nephrolithotomy in Treating Renal Calculi of 2 to 3 Cm in Size. Surgical Innovation, 26, 528-535. [Google Scholar] [CrossRef] [PubMed]
[9] 王新, 张军平, 马权. 经皮肾镜联合输尿管软镜治疗的上尿路结石患者术前中段尿、术中肾盂尿病原菌培养结果分析[J]. 中国乡村医药2023, 30(12): 39-40.
[10] Mogilevkin, Y., Sofer, M., Margel, D., Greenstein, A. and Lifshitz, D. (2014) Predicting an Effective Ureteral Access Sheath Insertion: A Bicenter Prospective Study. Journal of Endourology, 28, 1414-1417. [Google Scholar] [CrossRef] [PubMed]
[11] Traxer, O. and Thomas, A. (2013) Prospective Evaluation and Classification of Ureteral Wall Injuries Resulting from Insertion of a Ureteral Access Sheath during Retrograde Intrarenal Surgery. Journal of Urology, 189, 580-584. [Google Scholar] [CrossRef] [PubMed]
[12] Wang, J., Wang, Y., Yin, J. and Xia, L. (2024) Efficacy of Flexible Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Patients with Kidney Stones and Their Impact on Inflammatory Response and Renal Function. Annali Italiani di Chirurgia, 95, 220-226. [Google Scholar] [CrossRef] [PubMed]
[13] Wang, Q., Liu, J., Cao, J. and Ding, J. (2024) Clinical Efficacy and Safety of Flexible Ureteroscopy and Percutaneous Nephrolithotomy for Large Kidney Stones: A Retrospective Comparative Study. World Journal of Clinical Cases, 12, 4483-4490. [Google Scholar] [CrossRef] [PubMed]
[14] 杨宇. 肾盂输尿管结石夹角对输尿管软镜治疗肾下盏结石的影响[D]: [硕士学位论文]. 天津: 天津医科大学, 2020.
[15] 马魏魏, 高贇, 傅鑫华, 等. 输尿管软镜治疗肾盂肾下盏漏斗夹角≤ 30°肾下盏结石的诊治体会(附58例报告) [J]. 中国内镜杂志, 2022, 28(2): 68-72.
[16] 郑伟, 李永强, 庄承霖, 等. 输尿管软镜联合末端可弯曲输尿管软镜鞘治疗肾结石的临床研究[J]. 中国现代医学杂志, 2024, 34(16): 51-55.
[17] Peng, Y., Wang, L., Jin, J., Jiang, Y., Xu, Q., Yang, L., et al. (2023) Flexible Ureteroscopy under Local Anesthesia for Stone Management: Initial Exploration and Two-Year Experience. Postgraduate Medicine, 135, 755-762. [Google Scholar] [CrossRef] [PubMed]
[18] 王宁, 刘慧倩, 姚俊杰, 等. 局麻输尿管软镜碎石术治疗上尿路结石疗效及围手术期疼痛的危险因素[J]. 现代泌尿外科杂志, 2023, 28(11): 988-992.
[19] 段康, 刘齐贵, 王跃力, 等. 双J管预扩张输尿管软镜治疗肾结石363例疗效分析[J]. 中国微创外科杂志, 2015, 15(8): 692-694.
[20] 张军, 刘佳, 赵纪宇, 等. 输尿管软镜碎石术预置输尿管支架必要性的探讨[J]. 中国医刊, 2017, 52(3): 30-31.
[21] 王咸钟, 王忠, 何大鹏, 等. 术后支架置入时间对输尿管软镜碎石术治疗肾结石结局的影响分析[J]. 国际外科学杂志, 2020, 47(9): 619-623.
[22] Reicherz, A., Westhues, H., Häuser, L., Wenzel, P., Noldus, J. and Bach, P. (2021) A Randomized Prospective Study: Assessment of Transient Ureteral Stenting by Mono-J Insertion after Primary URS and Stone Extraction (Fast 3). Urolithiasis, 49, 599-606. [Google Scholar] [CrossRef] [PubMed]
[23] Chang, X., Wang, Y., Li, J. and Han, Z. (2021) Prestenting versus Nonprestenting on the Outcomes of Flexible Ureteroscopy for Large Upper Urinary Stones: A Systematic Review and Meta-Analysis. Urologia Internationalis, 105, 560-567. [Google Scholar] [CrossRef] [PubMed]