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观察

摘要

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.%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.