3D打印输尿管通道鞘鞘后装置在 ≥ 2.0 cm肾结石手术中的应用研究

Application of 3D printed posterior ureteral access sheath device in the operation of renal calculi ≥ 2.0 cm

摘要:

目的 探讨3D打印输尿管通道鞘（UAS）鞘后装置的有效性。方法 选择2019年1月－2020年12月该院使用输尿管软镜治疗 ≥ 2.0 cm肾结石的72例患者，采用随机数表法分成A组（n = 34）和B组（n = 38），A组为常规手术组，UAS后方自然出水，B组UAS后方连接3D打印装置，将负压传导至肾内，按需调节负压大小。比较两组患者灌注液使用量、术后发热率、手术时间、Ⅱ期手术率和结石清除率。结果 两组患者均成功置鞘并完成手术；B组灌注液使用量为（1 388.00±363.00）mL，较A组的（1 016.00±231.00）mL增加了36.6%，两组比较，差异有统计学意义（P = 0.000）；B组患者术后24 h发热率（T ≥ 37.5℃）为2.6%（1/38），与A组的23.5%（8/34）比较，差异有统计学意义（P = 0.011）；两组患者手术时间、Ⅱ期手术率和结石清除率比较，差异均无统计学意义（P > 0.05）。结论 3D打印的UAS鞘后装置能将负压吸力传递入肾盂，实现主动调节和按需调节，能提高灌注液流出速度，增加灌注流量，带走激光产生的热量，吸出部分粉尘，降低肾盂内压力，使输尿管软镜手术更安全。

Abstract:

Objective To investigate the effectiveness of 3D printed posterior ureteral access sheath (UAS) device.Methods 72 patients with renal calculi of maximum diameter ≥ 2.0 cm were selected, who was treated with holmium laser lithotripsy under flexible ureteroscopy from January 2019 to December 2020. All the patients divided into groups A (n = 34) and group B (n = 38) by table of random digit. Group A was conventional surgery group, and the water came out naturally after UAS, group B which in operations the access sheath was connected with a 3D-printed device to transmit negative pressure to the kidney that could adjust negative pressure as needed. The amount of perfusion fluid, postoperative fever rate, operation time, Ⅱ stage operation rate and stone clearance rate were compared between the two groups.Results The ureteral access sheath were successfully placed and the operations were completed in both groups. The amount of perfusion fluid in group B was significantly higher than that in group A [(1 388.00 ± 363.00) vs (1 016.00 ± 231.00) mL], group B increase over 36.6% compared with group A (P = 0.000). The fever rate (T ≥ 37.5℃) in group B was 2.6% (1/38) compared with 23.5% (8/34) in group A after operation in 24 h, and the difference was statistically significant (P = 0.011). There were no significant difference in operation time, Ⅱ stage operation rate and stone clearance rate between the two groups (P > 0.05).Conclusion The 3D-printed posterior ureteral access sheath device can transfer negative pressure into the renal pelvis to realize active regulation and adjustment of the pressure on demand, increase the inflow and outflow rate of perfusion fluid, take away the heat generated by laser, suck out part of stone dust, and reduce postoperative fever, to make the operation safer.