| Objective:Flexible ureteral lithotripsy is a safe and effective way to remove stones from the upper urinary tract,and the most important step in the surgical process is the use of ureteral access sheath,and there is no uniform standard for the depth of intraoperative ureteral access sheath insertion.Therefore,this study compares the clinical efficacy of disposable ureteral access sheath placed about 5 cm below the ureteropelvic junction and the ureteropelvic junction,and analyzes the advantages and disadvantages of the two insertion depths to provide reference for clinical treatment.Methods:The clinical data of patients with kidney stones admitted by the Department of Urology of Shanxi Bethune Hospital from December 2020 to December 2021 were retrospectively analyzed,and the exclusion criteria were included,and the ureteral access sheath of different lengths were selected according to the height difference,which were divided into ureteral long sheath group and short sheath group,and each group was then divided into two groups according to whether the ureteral access sheath was placed 5cm below the ureteropelvic junction or the ureteropelvic junction.By comparing the general data,operation time,postoperative creatinine level,incidence of postoperative complications(low back pain,fever)and stone-free rate of each group of patients,the counting data were expressed by Chi-square test(Fisher exact test),the metrological data was expressed by(Mean±SD),and the t-test was used,and all data were statistically analyzed by SPSS25.0 statistical software.Results:1.A total of 83 cases were included in this study,including 41 cases using long sheaths,of which 20 were placed in UPJ and 21 were placed below UPJ.There were 42 cases of short sheath use,of which 23 were placed in UPJ and 19 were placed below UPJ.2.In patients with long sheaths,The age of the ureteral access sheath placed below UPJ and UPJ was [(50±12)vs(44±12)years,P>0.05],BMI [(23.26±2.32)vs(23.72±1.82)kg/m2,P>0.05],stone diameter [(1.42±0.56)vs(1.28±0.56)cm,P>0.05],stone CT value [(767±127)vs(817±147),P>0.05],preoperative indwelling double J tube [50%(4/20)vs 23.8%(5/21),P>0.05].3.For short sheaths,The age of the ureteral access sheath placed below UPJ and UPJ was [(50±10)vs(51±11)years,P>0.05],BMI [(24.67±2.44)vs(25.26±2.77)kg/m2,P>0.05],stone diameter [(1.15±0.44)vs(1.25±0.44)cm,P>0.05],stone CT value[(703±167)vs(765±196),P>0.05],preoperative indwelling double J tube [30.4%(7/23)vs 28.6%(4/19),P>0.05].4.All surgeries were successfully sheathed,and in the long sheath group,the operation time of the two groups placed below UPJ and UPJ was [(67±38)vs(65±28)min,P>0.05],postoperative creatinine level [(77.9±14.62)vs(74.04±13.28)umol/L,P>0.05],postoperative low back pain [40%(8/20)vs 47.6%(10/21),P>0.05],postoperative fever [25%(5/20)vs 38.1%(8/21),P>0.05],stone-free rate [70%(14/20)vs 76.2%(16/21),P>0.05].5.In the short sheath group,the operation time of the two groups placed below UPJ and UPJ was [(66±26)vs(53±18)min,P>0.05],postoperative creatinine level[(72.77±11.05)vs(74.51±9.40)umol/L,P>0.05],postoperative low back pain [43.5%(10/23)vs 47.4%(9/19),P>0.05],postoperative fever [26.1%(6/23)vs 42.1%(8/ 19),P>0.05],stone-free rate [82.6%(19/23)vs 68.4%(13/19),P>0.05].Conclusion:1.In disposable flexible ureteroscopic surgery,the ureteral access sheath placed at UPJ or below UPJ can obtain good treatment results and high safety,and patients with mild ureteral stenosis in the upper ureter before surgery do not need to have a double J tube in one stage,and the same treatment effect can be obtained directly after primary flexible ureteroscopic surgery. |
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