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Pneumatic Lithotripsy Combined with TURP in the Treatment of Bladder Calculi with Benign Prostate Hyperplasia

目的:探討微創治療BPH并發膀胱結石的方法。方法:應用氣壓彈道碎石術聯合TURP治療BPH并發膀胱結石26例。結果:24例一次成功,1例一期碎石,二期行TURP;1例中轉開放手術。結論:氣壓彈道碎石術聯合TURP治療BPH并發膀胱結石創傷小,恢復快,安全高效。

Transurethral Lithotripsy Combined with Transurethral Resection of the Prostate in Treating Benign Prostatic Hyperplasia and Bladder Calculi

【摘要】　目的　探討良性前列腺增生（benign prostatic hyperplasia，BPH）伴膀胱結石的有效腔內治療方法。〖HTH〗方法　2003年6月-2009年12月，使用F26號電切鏡外鞘作為撐開器，氣壓彈道和（或）鈥激光粉碎膀胱結石，經尿道前列腺電切術 （transurethral resection of the prostate，TURP） 治療BPH伴膀胱結石86例。患者年齡58～83歲，平均68.6歲；病程2～8年，平均5.2年。術前患者國際前列腺癥狀評分（international prostate symptom score，IPSS）為（24.6±3.9）分，生活質量（5.7±0.6）分；前列腺重量（46.5±6.8） g，剩余尿量（185±58） mL，最大尿流率（5.7±2.3） mL/s。　結果　86例均一次手術成功。碎石時間為16~58 min，平均38 min；前列腺電切時間40~100 min，平均65 min。術中無并發癥發生。術后 5~8 d拔除尿管，平均6.5 d。術后4 例出現前尿道狹窄，經治療后痊愈。54例獲隨訪，隨訪時間2~6個月，平均3個月。術后2個月，54例最大尿流率升至（18.5±4.1） mL/s，剩余尿量下降至（16±22） mL，IPSS評分下降至（7.8±1.6）分，生活質量（2.5±0.3）分，與術前比較差異均有統計學意義（Plt;0.01）。　結論　經尿道碎石術和TURP一次性治療BPH伴膀胱結石安全、有效、經濟。【Abstract】　Objective　To explore an effective endourologic treatment method for benign prostatic hyperplasia (BPH) with bladder calculi. 　Methods　From June 2003 to December 2009, ballistic or holmium laser lithotripsy by outer sheath resectoscope and transurethral resection of the prostate (TURP) were performed on 86 patients with BPH and bladder calculi. The patients aged 58 to 83 years old, averaging at 68.6 years. Duration of their disease course ranged from 2 to 8 years, averaging 5.2 years. Before surgery, the international prostate symptom score (IPSS) was 24.6±3.9; the score of quality of life (QOL) was 5.7±0.6; prostatic weight was (46.5±6.8) g; residual urine (RU) volume was (185±58) mL; and the peak urine flow rate (Qmax) was (5.7±2.3) mL/s.　Results　The operations were completed successfully in all cases with a mean lithotripsy time of 38 min (16-58 minutes) and a mean TURP time of 65 min (40-100 minutes). No complications occurred during the operation. Urethral catheter was withdrawn 5-8 days after operation, with a mean period of 6.5 days. Four patients had anterior urethral stricture after operation, but recovered through treatment. Fifty-four patients were followed up for 2 to 6 months with an average follow-up time of 3 months. Two months after the operations, IPSS decreased to 7.8±1.6; Qmax increased to (18.5±4.1) mL/s; RU decreased to (16±22) mL and QOL was 2.5±0.3. Compared with preoperative conditions, the differences were all statistically significant (P＜0. 01).　Conclusion　Transurethral lithotripsy combined with TURP is an effective, safe and economical treatment for benign prostatic hyperplasia with bladder calculi.

經皮腎鏡鈥激光碎石術治療腎臟巨大鑄型結石的護理

目的　討論經皮腎鏡鈥激光碎石術治療腎臟巨大鑄型結石患者的護理方法及體會。 方法　2011年1月－2012年10月，對收治的10例腎臟巨大鑄型結石患者行經皮腎鏡鈥激光碎石術，并針對病癥特點給予精心的護理。 結果　9例患者行一、二期經皮腎鏡鈥激光碎石術后，其結石清除率平均達91.8%，術后恢復良好，無嚴重并發癥發生治愈出院；1例患者因結石過大，繼續行體外沖擊波碎石三期手術后好轉出院。 結論　精心細致的護理方法與措施是確保患者早日康復的重要因素。

微通道經皮腎輸尿管鏡聯合氣壓彈道碎石術在基層醫院的應用分析

目的探討微通道經皮腎輸尿管鏡聯合氣壓彈道碎石取石術（mini-PCNL）在基層醫院的應用療效和安全性。 方法對2010年3月－2013年3月收治的108例上尿路結石患者采用mini-PCNL予以治療，并就手術方式、手術時間、結石清除率等情況進行分析表述。 結果107例患者成功在B型超聲引導下建立經皮腎穿刺通道，1例腎下盞結石因腎臟大出血改開放手術行腎部分切除術，3例患者術中建立通道后出血較多安置腎造瘺管后行二期手術。手術時間為20～190 min，平均（78.0±40.1）min，結石總清除率78.5%，其中輸尿管上段結石單次清除率100.0%、腎結石單次清除率70.1%。術中平均出血量（105.0±45.6）mL，無胸膜、腹腔臟器、結腸損傷；平均住院7～14 d。 結論mini-PCNL治療上尿路結石具有較高的結石清除率、良好的安全性，同時具有術后恢復快、費用適中等優點，值得在基層醫院推廣應用。

Value of percutaneous transhepatic choledochoscopic lithotripsy in treatment of recurrent type Ⅱa hepatolithiasis

ObjectiveTo investigate the feasibility and safety of percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent type Ⅱa hepatolithiasis.MethodsAll of 293 patients with recurrent type Ⅱa hepatolithiasis admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2010 to December 2017 were collected retrospectively, 82 of whom were treated with the PTCSL (PTCSL group), 211 of whom were treated with traditional open surgery (open group). The patients were matched according to the ratio of 1∶1 by using the method of propensity score matching, then the patients were compared after matching.ResultsA total of 59 pairs were successfully matched, that was, there were 59 patients in the PTCSL group and open group, respectively. Compared with the open group, the PTCSL group had the similar conditions such as the gender, age, preoperative Child-Pugh classification, and times of previous biliary operations, etc. (P>0.050). There was no perioperative death in both groups. There were no significant differences between the two groups in the success rate, operation time, times of operations, time of T tube removal after operation, stone residual rate, and stone recurrence rate (P>0.050). Although the hospital costs of the PTCSL group was higher than that of the open group (P<0.050), the PTCSL group had various advantages, such as less intraoperative bleeding, smaller incisional scar, shorter hospital stay and postoperative ventilation time, and lower rate of total postoperative complications (P<0.050).ConclusionsAfter learning curve, PTCSL has many advantages over traditional open surgery in treatment of recurrent type Ⅱa hepatolithiasis. PTCSL is a minimally invasive surgery, which is safe and effective.

醫護合作-快速康復模式在經輸尿管鏡鈥激光碎石術中的應用及效果評價

目的 探討醫護合作-快速康復模式在經輸尿管鏡鈥激光碎石手術中的臨床應用及效果的評價。 方法 將 2015 年 10 月—2016 年 3 月入住的 166 例輸尿管結石患者隨機分為對照組和試驗組各 83 例，對照組按傳統方法進行住院治療及圍手術期護理，試驗組按照醫護合作-快速康復模式進行診治及護理，包括門診評估、術前檢查的完善、麻醉評估、流程辦理、家庭護理的注意事項、圍手術期的飲食活動指導和疼痛管理、健康保健等。比較兩組患者的住院時間、住院費用、術后并發癥、術后首次進食時間和滿意度的差異。 結果 試驗組患者住院時間[（22.46±0.89）h]少于對照組[（76.46±0.75）h]，住院費用[（8 275.21±789.45）元]低于對照組[（12 859.11±1 047.54）元]，并發癥發生率[10.8%（9/83）]低于對照組[41.0%（34/83）]，患者滿意度[（99.87±5.12）%]高于對照組[90.66±5.95）%]，差異均有統計學意義（P<0.05）。 結論 醫護合作-快速康復模式應用于輸尿管鏡鈥激光碎石手術，能充分利用醫療資源，促進醫患關系協調，縮短患者的住院日，減少患者的住院費用，降低術后并發癥的發生，促進術后康復，早日恢復患者的正常生活。

小兒體外沖擊波碎石的護理

目的　總結小兒體外沖擊波碎石圍手術期護理方法。 方法　2009年3月－2011年6月對56例行體外沖擊波碎石的泌尿結石患兒，術前完善各項篩查、抗感染工作，術后嚴密監測生命體征，予促石排泄指導，對相關并發癥及時處置，并做好出院指導等護理工作。 結果　56例患兒均順利完成體外沖擊波碎石手術。其中1例排石效果不理想于次日行手術切開取石，1例術后14 d復查結石仍未排凈行第2次排石術，其余54例患兒均一次性碎石成功。術后3個月門診隨訪，56例均無結石形成。 結論　術前完善的檢查及抗感染處置，術后排石的觀察與指導，及并發癥的預防護理是結石患兒體外碎石治愈成功的關鍵。

Treatment of Renal Pelvic Calculi by Transurethral Ureteroscopic Pneumatic Lithotripsy

目的:探討經尿道輸尿管鏡腔內氣壓彈道碎石治療腎盂結石的療效。方法:回顧分析7例腎盂結石經尿道輸尿管鏡腔內氣壓彈道碎石術式治療的臨床資料。結果:5例術后復查出現大小不等上尿路殘余結石,分別予經皮腎鏡碎石,經尿道輸尿管鏡碎石,體外振波碎石治療后復查無殘余結石。結論:腎盂結石經尿道輸尿管鏡腔內氣壓彈道碎石治療需要根據結石的大小、形態及位置嚴格掌握適應癥。

Pneumatic Ballistic Lithotripsy via Nephroscope in the Treatment of Bladder Stones

【摘要】　目的　探討腎鏡結合氣壓彈道碎石治療膀胱結石的臨床療效。　方法　分析2004年9月－2011年3月男性膀胱結石患者87例的臨床資料。結石直徑1.5~6.7 cm，使用腎鏡結合氣壓彈道碎石術治療，統計手術時間、手術并發癥。隨訪3個月，觀察有無尿道狹窄。　結果　所有患者碎石成功，平均手術時間為37 min，無殘留結石，無膀胱穿孔、感染性休克、膀胱大出血等并發癥；術后3個月隨訪，經尿道手術者均未發現尿道狹窄。　結論　腎鏡下氣壓彈道碎石術是治療膀胱結石安全、有效的方法。【Abstract】　Objective　To explore the clinical efficacy of pneumatic ballistic lithotripsy via nephroscope in treating patients with bladder stones.　Methods　We retrospectively analyzed the clinical data of 87 patients with bladder stones from September 2004 to March 2011. The diameter of the stones were ranged from 1.5 to 6.7 cm. The patients underwent peneumatic ballistic lithotripsy via nephroscope. We recorded the operation time and complications, and observed the incidence of urethrostenosis 3 months after the beginning of the follow-up.　Results　All stones were fragmented and removed successfully. The average operation time was 37 minutes. No residual stone, bladder perforation, infective shock or severe bleeding of the bladder occurred. During the 3-month follow-up, no utethrostenosis occurred.　Conclusion　Pneumatic ballistic lithotripsy via nephroscope is a safe and efficient technique in treating bladder stones.

經尿道前列腺電切及膀胱結石碎石術中膀胱內氣體爆炸一例