EMS第四代混合动力碎石清石系统在巨大膀胱结石治疗中的应用

Transurethral Nephroscopic The Fouth-generation Pneumatic Lithotripsy Combined with Ultrasound Lithotripsy for Huge Bladder Calculus

目的:探讨EMS第四代混合动力碎石清石系统在巨大膀胱结石治疗中的应用。方法:对4例巨大膀胱结石应用EMS第四代混合动力碎石清石系统进行治疗。结石直径4.0～5.5 cm,平均4.3 cm。单发结石3例,多发结石1例。其中合并良性前列腺增生2例,神经源性膀胱1例。术前完善B超、KUB+IVU或CT等检查。腰麻/硬膜外麻,取膀胱截石位,经尿道置入Wolf 20.8 F肾镜,采用瑞士EMS公司第四代混合动力碎石清石系统治疗。气压弹道频率调至8～12 Hz,超声能量设定为50%～60%,将碎石探杆经镜鞘插入,质地较脆的结石,直接用超声将其击碎并吸出;否则先用气压弹道碎石,将其击成碎块后,再用超声碎石清石系统粉碎后吸出。合并良性前列腺增生者,结石取净后再行前列腺汽化电切术。结果:4例一次碎石、清石成功。手术时间45～160 min,平均85 min。单纯碎石者留置尿管1～2 d,同期行前列腺汽化电切者留置导尿5～6 d。无1例出现膀胱破裂、尿道狭窄、感染、大出血等并发症。随访3～8个月,无结石复发。结论:应用EMS第四代碎石清石系统治疗膀胱结石具有安全、损伤小、恢复快、住院时间短、结石清除率高、并发症少等优点,是治疗巨大膀胱结石的优选方法,值得临床应用。

Objective：To explore the efficacy of transulethral nephroscopic the fouth-generation pneumatic lithotripsy com- bined with uhrasound lithotripsy for huge bladder calculus. Methods：By using transurethral F20.8 nephroseope and the fouth-generation EMS Lithocaster, transurethral nephroscopic pneumatic lithotripsy and uhrasound lithotripsy was per- formed on 4 patients with huge bladder calculus（ 3 men and 1 women） between November 2010 and April 2011. The diam- eter of the calculi was ranged from 4.0 to 5.5 cm, the mean diameter 4.3 cm. Among the patients,3 had one stone in the bladder, while 1 had muhiple calculi. 2 patients were complicated with BPH, 1 had neurogenic bladder. Pneumatic fre- quency was set at 8 - 12 Hz, and ultrasonic energy was 50% ~ 60% . For the patients with BPH electrovaporization abla- tion was plused. Results：All patients were cured in one session. The mean operation time was 85 minutes （45 to 160 mi- nutes ）. No patient had urethral stricture, infection, or massive hemorrhage during the operation. Follow-up was available in 4 patients for 3 tO 8 months. During the period, no recurrent calculi was found. Conelusions：Transurethral nephroseopic the fouth-generation pneumatic lithotripsy combined with uhrasound lithotripsy is effective for huge bladder calculus.