肾镜在下尿路结石治疗中的应用

Cystolithotomy through mephroscope

目的:探讨和推广应用肾镜和钬激光粉碎膀胱和尿道结石。方法:回顾性分析膀胱结石16例,尿道结石2例患者资料。结石大小1.5～4.5cm。先用扩张管带Peel-away鞘进入前尿道,至尿道球部时退出扩张管,保留Peel-away鞘。然后插入肾镜,在直视下进入膀胱。找到结石后,利用Peel-away鞘固定结石,置入钬激光进行碎石。碎石片直接经Peel-away鞘直视下冲洗出,无需用另外的冲洗球冲洗膀胱。结果:18例均成功碎石,手术时间18～45min,术后住院时间3～8d,2例尿道结石患者为门诊手术,碎石后即可带导尿管回家。术后10天随访,无结石残留,无尿道狭窄发生。结论:利用肾镜粉碎膀胱及尿道结石,其优点在于可以直视下用Peel-away鞘固定结石,减少结石碎片散落,并且碎石片直视下冲出,减少副作用,缩短手术时间。

Objective：To evaluate the effect of holmium laser lithotomy on urethra and bladder calculi through nephroscope. Method： Eighteen patients, 16 with bladder stones and 2 with urethral stones, were treated in our hospital with stone size of 1.5 4.5 cm. Firstly,dilator with Peel-away shea＇a were inserted into the anterior urethra, then dilator was withdraw and the Peel-away sheath was kept in urethra. So nephroscope was inserted into bladder through Peel-away sheath visually and the holmium laser fiber through nephroscope. Using Peel-away sheath to fix stones, and lithotripsy were finished visually. Finally, stone fragments were washed out through Peel-away sheath directly. Result： All patients had successful lithotripsy,operative time were 18-45 mins. For 2 outpatients with urethral calculi, they could go back home immediately with catheter. And other patients with bladder stones were observed for 3-8 days in hospital. No residual stones and urethral stricture happened 10 days after follow-up. Conclusion：By nephroscope,hohnium laser lithotomy of bladder and urethral calculi could greatly improve lithotripsy efficiency and shorten the operation time with less side effects by fixing stones with Peel away sheath directly and vis ually and reducing scatter of the stone fragments.