输尿管软镜治疗肾结石的现状和展望

输尿管软镜技术是泌尿外科领域一门新兴的微创技术。自从Marshall于1964年首次采用F9输尿管软镜检查输尿管结石以来,至今已有近50年的历史。最早的输尿管软镜没有操作通道,只能用于尿路疾病的检查。随着新型输尿管镜的不断开发,随着输尿管软镜相关辅助设备制造技术的进步,在上尿路疾病的诊治方面,输尿管软镜技术的应用越来越广泛。尤其在肾结石的治疗方面,输尿管软镜技术取得了长足进步,越来越多的泌尿外科医师倾向使用输尿管软镜技术处理肾结石。为此,本文就输尿管软镜进展及其治疗肾结石方面作一综述。     

输尿管软镜技术进展

输尿管软镜技术在近10余年有了长足的发展,其适应证也在不断扩大,然而由于学习曲线长、操作疲劳度高、价格昂贵、损耗率高等缺陷在临床推广上还存在限制。近年来有一系列输尿管软镜新技术,包括机器人辅助输尿管软镜、双工作通道输尿管软镜、一次性输尿管软镜、末端可弯输尿管硬镜等和附属器械的进展,让输尿管软镜手术能在更舒适和精确的条件下进行,同时还能降低治疗费用与器械损耗率。这些进步让输尿管软镜技术在泌尿外科的地位又上了一个新的台阶。本文对这些新的输尿管软镜技术进行综述。     

输尿管软镜碎石术治疗输尿管结石

<正>输尿管软镜手术是软镜通过尿道、膀胱,逆行进入输尿管腔、肾盂肾盏,并配合激光诊治上尿路疾病的一种手术方式,安全有效,创伤小,并发症少。目前,输尿管软镜已广泛应用于多种上尿路疾病的诊断与治疗,成为泌尿外科的一项常规诊疗技术。一、输尿管软镜碎石术概述1.输尿管软镜发展史:1964年,Marshall~([1])第一次将9F输尿管软镜应用于输尿管上段结石的诊断,真正意义上输尿管软镜的临床应用是1971年Takagi等~([2])     

现代输尿管镜在治疗泌尿系结石中的应用

<正>作为治疗泌尿系结石一种十分重要的技术,输尿管镜技术一直在向前发展着。尽管体外冲击波碎石(ESWL)和经皮肾镜碎石术(PCNL)也是被广泛接受而且发展充满活力,但输尿管镜治疗结石被认为是最成功的治疗方式,并且随着纤维光学和数字影像技术飞速发展,输尿管镜的适用范围逐步扩大,已经成为常规的治疗方式,现综述如下。1半硬式输尿管镜/输尿管软镜输尿管软镜可以处理到肾内的结石。在一些患者中,半硬式输尿管镜的长度可以到达肾盂,但是无法机动到全部集合系统。因此设计者考虑在镜体上加上转向控制,软镜应需诞生了,但它价格     

输尿管软镜治疗上尿路结石的现状与进展

泌尿系结石是泌尿外科最常见的疾病之一,其中多数为上尿路结石。受硬件条件限制,传统微创治疗方法的安全性和有效性均存在一定局限。相对而言,输尿管镜治疗上尿路结石因通过自然腔道进入肾脏,并在直视下进行碎石,故具有微创、安全、恢复快、碎石效率高等优点。近年来随着输尿管软镜技术及相关碎石辅助设备的快速发展,输尿管软镜碎石成为临床上治疗上尿路结石的理想选择。随着技术的进步及其普及推广,可以预见,输尿管软镜将成为未来治疗上尿路结石的主流术式。本文将从安全性、适应证等多方面介绍输尿管软镜治疗上尿路结石的安全性和有效性及相关技巧,以期有助于输尿管软镜技术的进一步普及推广。     

输尿管软镜技术治疗输尿管上段结石手术技巧探讨

目的 探讨输尿管软镜技术治疗输尿管上段结石的手术技巧.方法 96例输尿管上段结石患者接受一期输尿管软镜钬激光碎石治疗,先以Wolf 8.0 ～ 9.8F输尿管镜在镍钛导丝引导下直接扩张输尿管开口进入输尿管,沿导丝放置一次性导引鞘,遇到输尿管节段性狭窄时,在硬镜下直接置入输尿管球囊进行扩张,扩张后再置入输尿管导引鞘,引入输尿管软镜钬激光碎石,并使用套石篮套取出较大的结石碎片.结果 94例患者一期成功置鞘碎石,2例因输尿管狭窄难以置入输尿管软镜鞘.手术时间30～75 min,平均45 min.术后9例患者寒战发热,无其他严重并发症.术后1个月拔除D-J管,复查CT/KUB,结石清除率94.79％ (91/96).结论 输尿管软镜钬激光碎石技术是处理输尿管上段结石的有效手段,熟练掌握手术技巧及灵活采用辅助手段,能够显著提高一期输尿管软镜手术的置管成功率.     

European Urology:一种新的机器人输尿管软镜:发展和早期临床研究(IDEAL stage 1-2b)

随着医疗设备的重大改进,输尿管软镜在过去十年发展迅速。即使对于较大的肾结石,已成为一个可行的替代体外冲击波碎石术(ESWL)、经皮肾镜取石(PCNL)的治疗方式。但是输尿管软镜在操作技术上仍然具有挑战性,需要具体、熟练的腔内技术。且在操作输尿管软镜时,不能独自一人完成,需要助手协助完成灌注、放置光纤和套石篮等。绝大多数外科医师必须站立完成手术,人体姿态可造成骨骼疾病,同时也可对输尿管软镜造成不良影响。更有甚者,大     

输尿管软镜的临床应用

Marshall[1]于1964年首次报道输尿管软镜的临床应用以来,软镜及相关辅助设备的制造技术有了飞速进展,尤其是光纤技术的引入、主动弯曲功能的设计和工作通道的出现,大大提高了输尿管软镜的使用价值.目前,输尿管软镜手术已成为通过人体泌尿系自然腔道逆行进入肾盂、肾盏并配合以激光治疗肾脏结石,以及通过镜检和组织活检对其他上尿路疾病进行诊断和治疗的重要手术方式,因具备微创、安全和有效的特点,正在被越来越多的泌尿外科医生关注和使用.本文就输尿管软镜在泌尿外科的临床应用情况阐述如下.     

硕通镜联合输尿管软镜治疗最大直径>10mm上尿路结石的临床疗效分析

目的:分析硕通镜联合输尿管软镜碎石术治疗最大直径>10 mm上尿路结石的临床疗效。方法:回顾性分析2019年1月—2021年11月在东莞市人民医院行腔内镜治疗最大直径>10 mm上尿路结石患者的临床资料,其中行硕通镜联合输尿管软镜碎石术44例(硕通镜联合输尿管软镜碎石组),行传统输尿管软镜碎石术132例(输尿管软镜碎石组),比较两组患者的结石清除率、术后感染率、输尿管损伤发生率、住院费用等指标。结果:硕通镜联合输尿管软镜碎石组术后结石清除率为88.64%,高于输尿管软镜碎石组的72.73%;硕通镜联合输尿管软镜碎石组术后感染率为2.27%,低于输尿管软镜碎石组的13.64%;两组比较差异均有统计学意义(P<0.05)。结论:在腔内镜治疗最大直径>10 mm上尿路结石中,硕通镜联合输尿管软镜碎石术较传统输尿管软镜碎石术具有更高的结石清除率及更低的术后感染率,在临床治疗中值得推广。     

术前留置输尿管内支架管在导引鞘下输尿管软镜治疗婴幼儿肾结石的应用研究

目的探讨术前留置输尿管支架管在输尿管导引鞘下输尿管软镜治疗婴幼儿肾结石的临床疗效。 方法我院2015年6月至2018年6月收治24例肾结石婴幼儿（观察组）,行输尿管软镜下激光碎石,术前留置输尿管支架,被动扩张输尿管2周后再置入输尿管软镜导引鞘完成输尿管软镜下激光碎石术,并对比分析同期17例未置入输尿管软镜导引鞘行输尿管软镜下激光碎石术（对照组）的患者资料。 结果观察组结石清除率为87.5%,手术时间（56±14） min,术后发热1例,较对照组结石清除率76.5%明显提高,术后泌尿系感染发生率降低。 结论术前行输尿管支架被动扩张后置入输尿管软镜导引鞘提高输尿管软镜下碎石治疗婴幼儿肾结石手术的成功率及安全性。     

The utility of flexible endoscopy during advanced laparoscopy

Advanced laparoscopic techniques have continued to grow in prevalence for the treatment of gastrointestinal surgical conditions. The field of flexible endoscopy has also continued to increase the boundaries of its capabilities with the advent of purely flexible endoscopic techniques, such as in the treatment of gastrointestinal reflux disease.This article illustrates how flexible endoscopy can be used in combination with laparoscopy in a diverse number of operations in the human foregut and hindgut, such as reflux operations, esophageal myotomies, gastric resections, peptic ulcer operations, colon resections, and pancreatic pseudocyst operations. These examples of the utility of flexible endoscopy during laparoscopy show the marriage of these two disciplines. To be able to adequately use flexible endoscopy during laparoscopy, the surgeon will need to be skilled in flexible endoscopy, and the best way to maintain those skills is to use the flexible endoscopy in one's daily practice.     

Efficacy and safety of flexible versus rigid endoscopic third ventriculostomy in pediatric and adult populations: a systematic review and meta-analysis

Endoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between flexible and rigid approaches. A meta-analysis was conducted to compare efficacy and safety profiles of both techniques in pediatrics and adults. A comprehensive search was conducted on PubMED, EMBASE, and Cochrane until 11/10/2019. Efficacy was evaluated comparing incidence of ETV failure, while safety was defined by the incidence of perioperative complications, intraoperative bleedings, and deaths. Random-effects models were used to pool the incidence. Out of 1365 studies, 46 case series were meta-analyzed, yielding 821 patients who underwent flexible ETV and 2918 who underwent rigid ETV, with an age range of [5 days–87 years]. Although flexible ETV had a higher incidence of failure in adults (flexible: 54%, 95%CI: 22–82% vs rigid: 20%, 95%CI: 22–82%) possibly due to confounding due to etiology in adults treated with flexible, a smaller difference was seen in pediatrics (flexible: 36%, pediatric: 32%). Safety profiles were acceptable for both techniques, with a certain degree of variability for complications (flexible 2%, rigid 18%) and death (flexible 1%, rigid 3%) in pediatrics as well as complications (rigid 9%, flexible 13%), death (flexible 4%, rigid 6%) and intra-operative bleeding events (rigid 6%, flexible 8%) in adults. No clear superiority in efficacy could be depicted between flexible and rigid ETV for hydrocephalus treatment. Safety profiles varied by age but were acceptable for both techniques. Well-designed comparative studies are needed to assess the optimal endoscopic treatment option for hydrocephalus.

     

The use of traction methods to correct severe cervical deformity in rheumatoid arthritis patients: a report of five cases

STUDY DESIGN: A case series is presented. OBJECTIVES: To describe the methods of correction used in this study for flexible severe cervical deformity, and to report the results in patients with rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: Long-standing rheumatoid arthritis can lead to severe cervical deformity, causing significant functional deficits and poor cosmesis. Information on the use of traction combined with surgical stabilization to achieve correction of flexible deformity in rheumatoid patients is sparse in the English literature. METHODS: A review of five cases, including pertinent history, physical examination, radiographic evaluation, traction techniques, surgical stabilization, and outcomes, was conducted. RESULTS: Excellent correction of deformity and radiographic union were achieved in all the patients. One patient had minimal loss of correction after surgery and thereafter remained stable. Pin tract infections were the only significant complication. CONCLUSIONS: Severe cervical flexible deformity in rheumatoid patients can cause significant disability and can be treated successfully with a combination of traction techniques and surgical stabilization.     

Closed flexible intramedullary biopsy of metastatic carcinoma

Closed flexible intramedullary biopsy was performed in 24 patients requiring surgical stabilization of 17 pathologic and ten impending pathologic fractures from metastatic carcinoma. The biopsy was positive for carcinoma in 25 of 27 cases and either confirmed the diagnosis of metastatic disease or revealed a carcinoma cell type of unknown origin. The technique of closed biopsy using an intramedullary flexible, large bore, plastic catheter in patients with metastatic carcinoma produced information comparable to other biopsy techniques.     

Flexible ureteropyeloscopy with modular, "disposable" endoscope

A flexible modular ureteropyeloscope has been utilized in 36 patients. The flexible tips of this instrument can be replaced and have been available in sizes 6.0F, 8.5F, and 11.0F. The instrument was passed successfully into the ureter in 37 of 38 patients. The most frequent indications were surveillance for fragments after lithotripsy and for diagnosis of radiographic abnormalities in the upper tracts. The high success rate in these patients supports wider application of these techniques and indicates the potential for therapeutic procedures through flexible ureteroscopes.     

Transcervical Heller Myotomy Using Flexible Endoscopy

Introduction  

Esophageal achalasia is most commonly treated by laparoscopic myotomy. Transesophageal approaches using flexible endoscopy have recently been described. We hypothesized that using techniques and flexible instruments from our NOTES experience through a small cervical incision would be a safer and less traumatic route for esophageal myotomy. The purpose of this study was to evaluate the feasibility, safety, and success rate of using flexible endoscopes to perform anterior or posterior Heller myotomy via a transcervical approach.     

Flexible endoscopic Zenkers diverticulotomy with a novel bipolar forceps: a pilot study and comparison with needleknife dissection

Background  

Zenker’s diverticulum (ZD) is the most common diverticulum of the upper gastrointestinal tract. Various flexible endoscopic techniques have been used for division of the septum. However, the learning curve associated with these techniques might be difficult to overcome given the overall rarity of this condition. This can lead either to complications or to potential recurrence of symptoms. The authors hypothesized that a flexible bipolar hemostasis forceps developed for natural orifice translumenal surgery (NOTES) procedures would facilitate precise endoscopic diverticulotomy and simultaneously enable sealing of divided tissue edges.     

Preoperative assessment in patients with postintubation tracheal stenosis

Background Postintubation stenosis remains the most frequent indication for tracheal surgery. Rigid bronchoscopy has traditionally been considered the technique of choice for the preoperative diagnostic assessment. However, this technique is not routinely available, and new techniques such as flexible videobronchoscopy and spiral computed tomography (CT) scan with multiplanar reconstructions have been proposed as alternatives to rigid bronchoscopy. The aim of this study was to compare these techniques in the diagnostic assessment of patients with tracheal stenosis submitted to surgical treatment. Methods Twelve patients who underwent airway resection and reconstruction for postintubation tracheal and laryngotracheal stenosis were preoperatively evaluated with rigid and flexible bronchoscopy and with spiral CT scan with multiplanar reconstructions. The following parameters were examined: involvement of subglottic larynx, length of the stenosis, and associated lesions. The results were compared with the intraoperative findings. Results The accuracy of rigid bronchoscopy, flexible bronchoscopy, and CT scan in the evaluation of the involvement of subglottic larynx was, respectively, 92%, 83%, and 83%. The evaluation of the length of the stenosis was correct in 83%, 92%, and 25% of the patients, respectively, with rigid bronchoscopy, flexible bronchoscopy, and CT scan. A significant correlation was observed between the length of the stenosis measured intraoperatively and preoperatively with rigid (p < 0.001) and flexible bronchoscopy (p < 0.05) but not with CT scan (p = 0.08). The three techniques correctly showed the presence of an associated tracheoesophageal fistula in two patients, but CT scan did not correctly show the exact location of the fistula in relation to the airway. Flexible bronchoscopy was the only effective technique in the assessment of laryngeal function. Conclusions Rigid bronchoscopy remains the procedure of choice in the evaluation of candidates for tracheal resection and reconstruction for postintubation stenosis, and it should be available in centers that perform surgery of the airway. Flexible bronchoscopy and CT scan have to be considered complementary techniques in the evaluation of laryngeal function and during follow-up.     

Flexible fiberoptic bronchoscopy in the management of tracheobronchial foreign bodies in children: the value of a combined approach with open tube bronchoscopy

Fifty-two pediatric patients suspected of having a pulmonary foreign body but in whom there was insufficient evidence to warrant open tube bronchoscopy. In 19% of these patients, foreign bodies were found. Twenty-six percent of patients who had previously had foreign bodies removed and who subsequently underwent flexible bronchoscopy for a variety of indications were found to have residual foreign bodies. Clinically unsuspected foreign bodies were found in 1% of 1,054 additional patients who had flexible bronchoscopy for other reasons. The diagnostic use of the pediatric flexible bronchoscope is a safe, definitive, and cost-effective method for the identification of patients with pulmonary foreign bodies when other techniques yield equivocal or negative results. Patients known to have a foreign body should undergo open tube bronchoscopy for foreign body removal.     

Repair of the tibiofibular syndesmosis with a flexible implant

Fractures of the adult ankle with disruption of the tibiofibular syndesmosis require adequate stabilization of the ankle mortise to ensure satisfactory healing of the syndesmotic ligaments. Numerous internal fixation techniques for stabilization of the syndesmosis have been used. However, most techniques require partial device removal before weight bearing can be initiated. The "flexible syndesmosis repair" uses simple, inexpensive, readily available synthetic materials to restore distal tibiofibular stability. Once early fracture healing has been obtained, weight bearing is begun (average 6 weeks). Biomechanical testing on paired cadaver ankles demonstrated a suture tensile strength of 60 lbs and consistent suture-button strength of 49 lbs, whereas tricortical screw fixation was found to have a higher 82 lbs average pull-out strength, but demonstrated a wide variability depending on bone quality. Twelve patients have been managed with flexible syndesmosis repair and followed for 2-4 years. All fractures have healed without deformity and there are no cases of mortise instability. Subsequent analysis of devices removed 8-12 months following implantation has shown that all have remained intact without failure. The flexible syndesmosis repair is a reliable, stable way to restore syndesmosis integrity, allowing early weight bearing without need for interim surgery.