膨宫机在输尿管镜手术处理输尿管结石合并息肉的应用价值

Clinical application value of swelling palace machine during ureteroscopic lithotripsy in the treatment of ureteral calculi combined with polyps

目的评价膨宫机在输尿管镜碎石取石术处理输尿管结石合并息肉中的应用价值,探讨输尿管结石合并息肉的处理技巧。方法回顾我科行输尿管镜碎石取石术术中发现结石合并息肉的52例患者临床资料,其中输尿管上段结石18例,中下段结石34例,25例采用膨宫机持续灌注生理盐水扩张法行弹道碎石取石术(膨宫机辅助组),27例采用挂高水袋配合人工注水扩张法行弹道碎石取石术(传统碎石组);两组术中均常规留置双J管;比较两组的总手术时间、碎石时间、结石清除率、术中及术后并发症情况。结果 52例患者均全部成功碎石,无一例中转开放手术,两组均无输尿管断裂、撕脱并发症发生,传统碎石组1例术中发生输尿管穿孔。膨宫机辅助组与传统碎石组的总手术时间分别为31.2±5.1VS37.0±6.2min(t=-3.68,P=0.0006<0.05),碎石时间分别为6.5±1.4VS9.4±1.5min(t=-7.19,P=0.0000<0.05);传统碎石组有1例上段结石术中上移至肾盂,术后采用体外冲击波碎石清除结石。两组患者术后均得到3个月～1年随访,超声复查均未见结石残留及输尿管狭窄并发症发生。结论术中应用膨宫机持续灌注生理盐水扩张输尿管结合一定的弹道碎石技巧能使术野保持清晰,可明显减少总手术时间、碎石及清石时间,疗效确切,在输尿管镜处理输尿管结石合并息肉中有重要的临床应用价值。

Objective To evaluate the clinical value of swelling palace machine during ureteroscop- ic pneumatic lithotripsy in the treatment of ureteral calculi combined with polyps, in order to explore the surgery techniques. Methods Clinical date of 52 patients who underwent ureteroscopic pneumatic lithotripsy and were found with polyp surrounding ureter calculi were reviewed. Among them, ,18 cases were upper ureter stone and 34 cases were middle-lower ureteral stone. 25 cases used swelling palace machine to inject normal saline for keeping clear operation view （swelling palace machine-assisted group）. 27 cases used a high handled water bag with artificial water injection （traditional pneumatic lithotripsy group）. Dou- ble J stent was put in both groups. Total operation time, time of stone removal, stone clearance rate and surgery complications were compared between two groups. Results All operations were successful with no case transferred to open surgery. No ureter breakage or avulsion occurred in two groups. One case in tradi- tional pneumatic lithotripsy suffered from ureter perforation. Total operation time in swelling palace ma- chine-assisted group and traditional pneumatic lithotripsy group were 31.2±5.1 min VS 37.0±6.2 min （t=- 3.68, P=0.0006〈0.05）. Time of stone removal were 6.5±1.4 min VS 9.4±1.5 min （t=-7.19, P=0.0000〈0.05）. Stone clearance rate were 100% （25/25） VS 96.3% （26/27） with upper ureter stone in one case of traditional pneumatic lithotripsy group immigrated to renal pelvis, which was treated by extraorgan shock wave lithotripsy after surgery. All patients in two groups received 3 months to 1 year follow-up. B-ultrasound showed no residual stones and postoperative ureteral stricture occurred in both groups. Conclusions Intraoperative infusion of saline by swelling palace machine with some gravel techniques can maintain a clear operation field and favor stone removal, resulting in less time of stone clearance during ureteroscopic pneumatic lithotripsy. It has important clinical value in the treatment of ureteral calculi combined with polyps.