经电切镜外鞘输尿管镜下气压弹道碎石治疗膀胱结石

Ureteroscopy pneumatic lithotripsy with assistance of prostate resectoscope sheath in the treatment of bladder calculi

目的评价电切镜外鞘辅助输尿管镜气压弹道碎石取石术处理膀胱结石的应用价值，探讨该方法的手术技巧。方法回顾分析98例膀胱结石行输尿管镜碎石取石的患者临床资料，其中，52例采用电切镜外鞘辅助输尿管镜气压弹道碎石取石术（镜鞘辅助组），46例直接采用输尿管镜气压弹道碎石取石术（传统碎石组）；两组术后均常规留置18F三腔导尿管；比较两组的手术时间、结石清除率及手术并发症情况。结果98例均全部成功碎石取石，无一例中转开放手术；镜鞘辅助组与传统碎石组的手术时间为（44．4±5．1）minVS（53．2±6．2）min（t=-7．71，P〈0．01），传统碎石组术中2例发生膀胱穿孔，予留置尿管持续引流治愈；两组术后均得到3个月～1年随访，传统碎石组术后1例发生尿道狭窄，予定期尿扩治愈；两组超声随访复查均未见结石残留或复发。结论术中应用电切镜外鞘辅助输尿管镜气压弹道碎石取石能使术野保持清晰，减少输尿管镜反复进出损伤尿道，结合一定的弹道碎石技巧可明显缩短手术时间，疗效确切，在输尿管镜处理膀胱结石中有重要的临床应用价值。

Objective To evaluate the clinical value of a novel method with assistance of prostate resectoscope sheath during ureteroscopic pneumatic lithotripsy in the treatment of bladder calculi, in order to explore the surgery techniques. Methods Clinical date of 98 bladder calculi patients who underwent ureteroscopic pneumatic lithotripsy were reviewed. Among them, 52 cases underwent ureteroscopic pneumatic lithotripsy with assistance of prostate resectoscope sheath （Sheath assistant group） and 46 cases performed ureteroscopic pneumatic lithotripsy directly （traditional lithotripsy group）. 18F three-cavity catheter was put in both groups. Operation time, stone clearance rate and surgery complications were compared between two groups. Results All operations were successful with no case transferred to open surgery. Operation time in sheath-assisted group and traditional lithotripsy group were 44.4±5.1 min VS 53.2±6.2 min （t=-7.71, P〈0.01）. Two cases in traditional lithotripsy suffered from badder perforation. All patients in two groups received 3 months to 1 year follow-up. B-ultrasound showed no residual stones. Postoperative Urethral stricture occurred in one case in traditional group. Conclusions Intraoperative assistance of prostate resectoscope sheath may maintain a clear operation field and reducing urethral injury,which combine some gravel techniques can favor stone removal, resulting in less time of stone clearance during ureteroscopic pneumatic lithotripsy. It has important clinical value in the treatment of bladder calculi.