CAJ | 학술논문

目的探讨经尿道持续冲洗镜鞘联合钬激光一期碎膀胱巨大结石的效果.方法选取2010年3月至2014年2月于广东省阳江市阳东区人民医院治疗的23例膀胱巨大结石患者,经尿道置入前列腺电切镜鞘进行持续冲洗膀胱,钬激光光纤从电切攀通道置入碎石.其中17例合并良性前列腺增生患者同期行经尿道前列腺切除术(TURP).结果 23例患者均手术成功,一期膀胱巨大结石清除率为100％,平均碎石时间为(56.0 ±2.3)min.6例行经尿道碎膀胱结石手术患者,术后拔尿管时间为(2.00±0.21)d,17例同期行经尿道碎膀胱结石及TURP患者,术后拔尿管时间为(5.00 ±0.39)d.23例患者均未发生大出血、前列腺电切综合征、膀胱穿孔及脓毒血症等围术期并发症,随访3 ～15个月均无结石复发及尿道狭窄等严重并发症.结论经尿道持续冲洗镜鞘联合钬激光碎膀胱巨大结石,应用高功率钬激光及大通道镜鞘,碎石速度快,残余结石取净率高,术中视野持续清晰,手术时间短,合并良性前列腺增生同期行TURP,安全、微创.
목적 탐토경뇨도지속충세경초연합화격광일기쇄방광거대결석적효과.방법 선취2010년3월지2014년2월우광동성양강시양동구인민의원치료적23례방광거대결석환자,경뇨도치입전렬선전절경초진행지속충세방광,화격광광섬종전절반통도치입쇄석.기중17례합병량성전렬선증생환자동기행경뇨도전렬선절제술(TURP).결과 23례환자균수술성공,일기방광거대결석청제솔위100％,평균쇄석시간위(56.0 ±2.3)min.6례행경뇨도쇄방광결석수술환자,술후발뇨관시간위(2.00±0.21)d,17례동기행경뇨도쇄방광결석급TURP환자,술후발뇨관시간위(5.00 ±0.39)d.23례환자균미발생대출혈、전렬선전절종합정、방광천공급농독혈증등위술기병발증,수방3 ～15개월균무결석복발급뇨도협착등엄중병발증.결론 경뇨도지속충세경초연합화격광쇄방광거대결석,응용고공솔화격광급대통도경초,쇄석속도쾌,잔여결석취정솔고,술중시야지속청석,수술시간단,합병량성전렬선증생동기행TURP,안전、미창.
Objective To investigate the effect of transurethral endoscopic sheath continuous irrigation combined with holmium laser lithotripsy on one stage treatment of huge bladder calculi.Methods Totally 23 patients with bladder large calculi from March 2010 to February 2014 were enrolled.Continuous bladder irrigation was performed after transurethral resectoscope sheath placement and the bladder gravels were broken by holmium laser optical fiber from transurethral channel placement.Concomitant transurethral resection of prostate (TURP) was performed in 17 cases complicated with benign prostate hyperplasia (BPH).Results One stage operations were all successfully performed in 23 patients,with a stone clearance rate of 100％;the gravel duration was (56.0 ± 2.3) min.In 6 patients undergoing transurethral urethral bladder stones surgery,the time of catheter removal was (2.00 ±0.21) d;in 17 BPH patients undergoing concomitant TURP,the time of catheter removal was (5.00 ± 0.39) d.No bleeding,transurethral resection syndrome,intraoperative bladder perforation and sepsis occurred;during 3-15 months of follow-up period,there was no recurrence of stone and urinary tract serious complications such as stenosis.Conclusion Transurethral continuous irrigation combined with holmium laser lithotripsy with high power laser and big channel mirror sheath has a high stone clearance rate in huge bladder calculi,with a clear surgical field and a short operation time;in patients with BPH,concomitant TURP can be performed,being safe and minimally invasive.