经尿道肾镜下治疗常见膀胱结石效果分析

Effect analysis of treatment for common bladder calculus under transurethral nephroscope

目的：分析经尿道肾镜下治疗常见膀胱结石的临床效果，为碎石方案选择提供参考依据。方法随机选取2010年至2014年经尿道内镜下碎石治疗的膀胱结石患者60例，结石直径均在1.5~2.5 cm。2012年后应用肾镜下气压弹道或超声碎石治疗的病例30例作为观察组，其中应用气压弹道碎石治疗的15例作为观察一组，应用超声碎石治疗的15例作为观察二组；2012年前应用膀胱镜下大力碎石钳治疗的30例作为对照组，分别比较各组间患者的手术时间、一次结石取净情况及并发症发生情况。结果观察组与对照组的手术时间分别为（21.3±6.0）min、（35.8±8.2）min，一次性取净结石例数分别为30例、21例，出血并发症例数分别为2例、10例，两组对比差异均有统计学意义（P ﹤0.05）；观察组与对照组在膀胱黏膜破裂并发症上比较差异未见统计学意义（P ﹥0.05）。观察组一组与二组的手术时间分别为（21.7±6.8）min、（21.0±5.4）min，两组差异未见统计学意义（P ﹥0.05）；两组的一次净石率与并发症均相同。结论经尿道肾镜下碎石治疗膀胱结石手术时间短、一次性净石率高、出血等并发症少，效果明显优于膀胱镜下大力碎石钳碎石。在经尿道肾镜下治疗1.5~2.5 cm 的结石时，气压弹道与超声两种碎石工具的效果相当，未见显著差别。

Objective To analyze the clinical effect of treatment for common bladder calculus under transurethral nephroscope, in order to provide references for choosing of lithotripsy plan. Methods Sixty patients with bladder stones treated by lithotripsy under transurethral endoscope since year 2010 to 2014 were randomly chosen,and the diameter of their stones range were 1. 5 -2. 5 cm. Thirty cases were treated by pneumat-ic lithotripsy or ultrasond lithotripsy under nephroscop since 2012 were chosen as the observation group. Among them,fifteen cases treated by pneumatic lithotripsy were the first observation group,fifteen cases treated by ultrasond lithotripsy were the second observation group;thirty cases treated by strong lithotrite under cystoscope before 2012 were the control group. Then the paper compared patients’duration of op-eration,one-time stone clearance situation,and occurrence of complications between groups respectively. Results As to the observation group and the control group,the mean operation time of them were （21. 3 ± 6. 0）min and（35. 8 ± 8. 2）min respectively,the case with one-time complete stone clearance were 30 cases and 21 cases respectively,and the case with bleeding complications were 2 cases and 10 cases respectively. These difference between the two groups showed significant differences（ P ﹤0. 05）. While the difference in the rupture complications of bladder mucosa between the two groups had no significant difference（P ﹥ 0. 05）. As to the first observation group and the second observation group, the mean operation time of them were（21. 7 ± 6. 8）min and（21. 0 ± 5. 4）min respectively,and the differences between the two groups had no significant difference（P ﹥ 0. 05）;the one-time stone clearance rate and complications were the same without significant difference. Conclusions With respect to the treatment of bladder calculus,the effect of lithotripsy under transurethral nephroscope is obviously better than that of strong lithotrite under cystoscope,as the former has shorter operation time and higher one-time stone clearance rate with less bleeding and other complications. There are no significant difference between pneumatic lithotripsy and ultrasond lithotripsy,when treating bladder calculus with the diameter of 1. 5 cm to 2. 5 cm under nephroscope,as they have the same effect.