肾筋膜扩张鞘联合气压弹道碎石术治疗膀胱结石

摘要

Objective:To explore the effects of renal sheath dilator combined with nephroscope in pneumatic lithotripsy for bladder stone treatment.Methods:A total of of 33 patients including 31 males and 2 females,with a median age of 63.7 years (58～81 years) and bladder stones of 20～45 mm in diameter have been enrolled.A renal sheath dilator was placed into the urinary meatus,and under a nephroscope the bladder stones were treated with pneumatic lithotripsy.Results:All stones have been successfully fragmentized and the mean operation time was 25.6 min (15～65 min).Three cases had pink hematuria after operation,but recovered 1～2 days later.In 2 cases,mild urethral mucosa scratches appeared after operation.However,no postoperative fever,urinary tract or bladder perforation and other serious complications occurred.Conclusions:The combination of renal sheath dilator with nephroscope for pneumatic lithotripsy is a valuable method for the treatment of bladder stones in adult patients,especially for huge bladder stones.It is highly efficient and labor-saving.%目的:探讨肾筋膜扩张鞘联合肾镜下气压弹道碎石治疗膀胱结石的疗效.方法:膀胱结石患者33例,结石直径20～45mm,通过尿道口置入肾筋膜扩张鞘后,在肾镜直视下采用气压弹道碎石术治疗膀胱结石.结果:所有结石均一次性粉碎成功,手术时间15～65 min,平均25.6 min.术后1～2 d复查膀胱B超或肾脏、输尿管及膀胱X线平片未见结石残留,导尿管在术后1～2 d拔除；同期行经尿道前列腺电切术者导尿管在术后3～7 d拔除.术后出现淡红色血尿3例,均在1～2 d后好转；出现尿道黏膜轻度刮伤2例.术后无尿道狭窄、大出血、膀胱穿孔等严重并发症.结论:采用肾筋膜扩张鞘作为通道联合肾镜下气压弹道碎石术治疗成年膀胱结石患者效果满意,尤其对巨大膀胱结石更具优势,更省时、省力、安全,操作更简便.