■本研究的目的是通过使用不同的输尿管入路鞘(UAS)尺寸和不同的UAS定位来评估肾盂动脉系统不同位置的流出变化。
■实验装置包括麻醉猪模型,在工作通道中插入200μm激光光纤的7.5-Fr输尿管镜,手持式抽水灌溉系统,和不同尺寸的UAS,即:9.5/11.5Fr,12/14Fr,和14/16Fr。每个UAS都放置在输尿管肾盂交界处(UPJ)下方或输尿管中部。输尿管镜放在肾盂,上部和下部花萼,在每个实验装置中,通过3秒间隔泵送一分钟来获得流出测量值。
■UAS在输尿管中段的定位与较低花萼中明显较高的流出率相关(p=0.041)。当UAS低于UPJ时,我们观察到下部花萼的流出率下降的趋势,当UAS在输尿管中段时完全倒置。将UAS大小从9.5/11.5Fr增加到12/14Fr导致肾盂和上花萼的流出显着增加(p=0.007),但不是在下部花萼。进一步增加至14/16Fr不产生增加的流量。
■pyelocaliceal系统的不同位置在fURS期间具有不同的流体力学。在肾盂和上花萼中,增加UAS的直径改善了流出,而在下部花萼中,UAS的位置似乎是最相关的因素。执行fURS时应考虑这些变量,尤其是高功率激光碎石术。
UNASSIGNED: The aim of this study was to evaluate outflow variation in different locations of the pyelocaliceal system with the use of different ureteral access sheath (UAS) sizes and different UAS positioning.
UNASSIGNED: The experimental setup included an anaesthetised porcine model, a 7.5-Fr ureteroscope with a 200-μm laser fibre inserted in the working channel, a hand-held pumping irrigating system, and UAS of different sizes, namely: 9.5/11.5 Fr, 12/14 Fr, and 14/16 Fr. Each UAS was placed just below the ureteropelvic junction (UPJ) or in the mid-ureter. The ureteroscope was placed in the renal pelvis, upper and lower calyces, and outflow measurements were obtained with 3-second interval pumping for one minute in every experimental setup.
UNASSIGNED: The UAS positioning in the mid-ureter was associated with significantly higher outflow rates in the lower calyx (p = 0.041). While the UAS was below the UPJ, we observed a trend of lower outflow rate in the lower calyx, which was completely inverted when the UAS was in the mid-ureter. Increasing the UAS size from 9.5/11.5 Fr to 12/14 Fr led to a significant increase in outflow in the renal pelvis and upper calyx (p = 0.007), but not in the lower calyx. A further increase to 14/16 Fr did not produce increased flow.
UNASSIGNED: Different locations of the pyelocaliceal system have different fluid mechanics during fURS. In the renal pelvis and upper calyx increasing the diameter of the UAS improved the outflow, whereas in the lower calyx the position of the UAS seems to be the most relevant factor. These variables should be considered when performing fURS, especially with high-power laser lithotripsy.