CAJ | 학술논문

目的评价孙氏末段可弯硬性输尿管肾镜(简称孙氏镜)行输尿管及肾脏内镜手术的安全性和可行性.方法 2014年6月对孙氏镜进行体外测试和动物实验.体外测试孙氏镜在空载、置入200 μm光纤以及1.7F镍钛合金套石篮时的弯曲度.选取6个月龄雌性约克夏长白猪9只,体质量(52.2±5.2)kg.使用孙氏镜探查输尿管和肾.X线引导和内镜直视下,孙氏镜以硬镜模式按硬性输尿管镜上镜方式逆行进镜,至肾盂输尿管连接处后,将内部可弯末段伸出,按照肾盂、上盏、中盏、下盏的顺序探查集合系统,并通过内镜工作通道直接注入造影剂行肾盂造影检查,观察有无遗漏肾盏.最后在空载、置入200 μm光纤以及1.7F套石篮3种状态下比较内镜探查肾盏能力的变化情况.完成各项操作后退镜.结果体外测试孙氏镜空载、置入200 μm光纤以及1.7F套石篮时的上/下弯曲度分别为251°/270°、238°/249°和265°/249°.动物手术均一次上镜成功.上镜时间20～95 s,平均为(54.9±22.6)s,输尿管生理性狭窄和扭曲均能通过.探查集合系统时间120～378 s,平均为(218.3±69.4)s.经逆行肾盂造影检查确认9只猪共177个肾盏,孙氏镜能进入并探查170个肾盏,探查完成率为96％.工作通道置入200 μm光纤后,有5个肾盏无法再次进入;置入1.7F套石篮后肾盏探查能力无变化.退镜时观察及逆行造影检查无输尿管损伤、穿孔等并发症.退镜后检查内镜视野无坏点,弯曲度无下降.结论动物实验结果表明孙氏镜行输尿管及肾脏内镜手术安全、有效.
목적 평개손씨말단가만경성수뇨관신경(간칭손씨경)행수뇨관급신장내경수술적안전성화가행성.방법 2014년6월대손씨경진행체외측시화동물실험.체외측시손씨경재공재、치입200 μm광섬이급1.7F얼태합금투석람시적만곡도.선취6개월령자성약극하장백저9지,체질량(52.2±5.2)kg.사용손씨경탐사수뇨관화신.X선인도화내경직시하,손씨경이경경모식안경성수뇨관경상경방식역행진경,지신우수뇨관련접처후,장내부가만말단신출,안조신우、상잔、중잔、하잔적순서탐사집합계통,병통과내경공작통도직접주입조영제행신우조영검사,관찰유무유루신잔.최후재공재、치입200 μm광섬이급1.7F투석람3충상태하비교내경탐사신잔능력적변화정황.완성각항조작후퇴경.결과 체외측시손씨경공재、치입200 μm광섬이급1.7F투석람시적상/하만곡도분별위251°/270°、238°/249°화265°/249°.동물수술균일차상경성공.상경시간20～95 s,평균위(54.9±22.6)s,수뇨관생이성협착화뉴곡균능통과.탐사집합계통시간120～378 s,평균위(218.3±69.4)s.경역행신우조영검사학인9지저공177개신잔,손씨경능진입병탐사170개신잔,탐사완성솔위96％.공작통도치입200 μm광섬후,유5개신잔무법재차진입;치입1.7F투석람후신잔탐사능력무변화.퇴경시관찰급역행조영검사무수뇨관손상、천공등병발증.퇴경후검사내경시야무배점,만곡도무하강.결론 동물실험결과표명손씨경행수뇨관급신장내경수술안전、유효.
Objective To evaluate the efficacy and safety of the Sun's tip-flexible ureterorenoscope (tf-URS) for retrograde ureteral and intrarenal surgery in porcine model.Methods Retrograde ureteral and intrarenal surgery was performed bilaterally in nine female yorkshire porcines with six-month old in June 2014.The average weight of the procines was (52.2 ± 5.2)kg.In vitro evaluation of maximum deflection was firstly conducted with no working instruments,200 μm laser fiber and 1.7F basket were inserted,and then followed the in vivo operation.The tf-URS was advanced through the ureter under visual and X-ray direction in its "rigid mode".When the endoscope reached the ueteropelvic junction,the inner flexible part was extended out to perform the full inspection of the collecting system,according to the sequence of pelvis,upper calces,middle calces and lower calces.Retrograde pyelography to determine whether any calyces were missed on entry was performed.Reproducibility and stability test were also conducted to verify whether there was a decrease with a 200 μm laser fiber or a 1.7F basket insertion in the working channel.Results In vitro deflection of tf-URS were 251°/270° with empty working channel,238°/249° with 200 μm laser fiber and 265°/249° with 1.7F basket insertion,respectively.The success rate of the endoscope introduction was 100％ and the average time was (54.9 ± 22.6)s (range 20-95 s).All physiological stricture or torsion could be easily passed.The mean inspection time was(218.3 ± 69.4)s (range 120-378 s).Of all 177 calyes,170 (96.0％) could be adequately entered and capacity of inspection decreased by 2.9％ (5/170) with 200 μm laser fiber and 0％ (0/170) with basket introduced,respectively.There was no sign of complications and endoscopic damage occurred after all there examinations.Conclusion The tf-URS is safe and effective tools for retrograde ureteral and intrarenal surgery,even with auxiliary instruments.