灌注液温度对输尿管镜手术效果的影响

向俊　刘湘鄂　林晨　何颖　李晨

[关键词] 输尿管镜;钬激光碎石术;输尿管结石;灌注液;温度

[中图分类号] R699          [文献标识码] A          [文章编号] 1673-9701（2021）22-0004-04

The influence of perfusate temperature on the effect of ureteroscopy

XIANG Jun   LIU Xiang′e   LIN Chen   HE Ying   LI Chen

Department of Urology， the Third People′s Hospital of Jingzhou City in Hubei Province， Jingzhou   434001， China

[Abstract] Objective To evaluate the effect of perfusate at different temperatures on the effect of ureteroscopic holmium laser lithotripsy. Methods A total of 144 patients with ureteral calculi needing ureteroscopic holmium laser lithotripsy who were admitted to our hospital from March 2018 to November 2020 were selected as the research objects， and randomly divided into the normal temperature isotonic saline perfusion group（n=75） and 38℃ isotonic saline perfusion group（n=69）. The operation time， body temperature changes， stone uplift rate， surgical complications， stone removal rate， secondary surgery or extracorporeal lithotripsy rate of the two groups of patients were recorded and compared. Results The operation time was （35.70±9.11） minutes in the 38℃ isotonic saline perfusion group， which was shorter than that of （42.88±8.75） minutes in the normal temperature isotonic saline group， and the difference was statistically significant （P<0.05）. The body temperature change， stone uplift rate， stone removal rate， surgical complications rate， secondary surgery or extracorporeal lithotripsy rate in the 38℃ isotonic saline perfusion group were significantly lower than those in the normal temperature isotonic saline group， and the difference was statistically significant（P<0.05）. Conclusion Compared with normal temperature isotonic saline， the use of 38℃ isotonic saline perfusion during ureteroscopy can significantly improve the laxity of the ureter，reduce the incidence of surgical complications， prevent the stone from moving up， and does not increase the patient′s hospitalization costs. It is worthy of clinical promotion.

[Key words] Ureteroscopy; Holmium laser lithotripsy; Ureteral calculi; Perfusate; Temperature

輸尿管结石是一种泌尿外科常见病，可导致疼痛、血尿、感染等多种症状，当药物治疗或体外震波碎石无效时，常需采用输尿管镜钬激光碎石术处理[1]。在输尿管镜钬激光碎石术中，需要使用等渗盐水灌注液进行冲洗，以保证清晰的视野和手术的正常进行。灌注液的不正确使用，会导致结石上移、肾周积液、泌尿系感染加重等后果;术中大量的低体温灌注液反复冲洗术野，会带走大量的热量，导致患者体温的改变，造成多器官的功能受限，严重时会导致尿源性脓毒血症[2]。近几年行输尿管镜钬激光碎石术时发现，在使用常温等渗盐水灌注液进行灌注时，输尿管痉挛的发生率较高，而将灌注液加热后，输尿管痉挛的发生率下降。本研究采用前瞻性研究评估常温等渗盐水灌注液和38℃等渗盐水灌注液对输尿管镜钬激光碎石术手术效果的影响，现报道如下。