目的 探討經膽道鏡等離子體沖擊波碎石術（PSWL）應用效果及操作技巧。方法 我院2004～2009年期間經膽道鏡行PSWL破碎巨大殘留結石56枚（54例），其中殘留結石直徑≤10 mm 9枚，10 mmlt;直徑≤15 mm 24枚，15 mmlt;直徑≤20 mm 17枚，直徑＞20 mm 6枚； 24例合并膽管狹窄。首先經膽道鏡找到需要破碎的結石，將碎石器導線電極經膽道鏡操作通道引入膽管距結石表面0.5～1.0 mm處，然后接通電源，擊發、碎石。結果 本組54例患者中，48例行PSWL 1次，2例2次，2 例3次，2例4次。PSWL每次碎石時發放沖擊波4～300次,平均65次; 每枚結石破碎所需發放沖擊波累計4～680次,平均77次。PSWL應用后結石均有不同程度破碎，其中完全碎裂20例。所有結石均被取凈。除1例合并膽管狹窄者術中發現膽管少量出血外，其余病例均無術中、術后并發癥。結論 PSWL技術對膽管結石有較強的破碎作用，對于較難取出的肝內嵌頓結石，有時可起到很好的效果，特別對于表面粗糙的色素結石，效果尤為顯著。
【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.
【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.
