Cataract surgery in aged patients:phacoemul-sification or small-incision extracapsular cataract surgery

AIM: To evaluate the effects and safety of phacoemulsification (Phaco) or small-incision extracapsular cataract surgery (SICS) and intraocular lens (IOL) implantation for aged patients. METHODS: Totally 137 aged patients (149 eyes) underwent cataract operation in the case of stable systemic condition, the blood pressure less than 160/95mmHg, blood glucose less than 8mmol/L, and under the help of electrocardiogram surveillance by anesthesiologists during the operation. 106 aged patients (114 eyes) underwent Phaco while 31 aged patients (35 eyes) underwent SICS. The postoperative visual acuity, corneal endothelial cell loss, surgery time and major complications were observed and analyzed retrospectively. RESULTS: The best-corrected visual acuity (BCVA) of >= 0.6 was achieved in 135 eyes (92.6%) at 1 month postoperatively (chi(2)=259.730, P<0.001). For aged patients, both Phaco and SICS could significantly improve visual acuity with no significant difference (chi(2)=4.535, P > 0.05). Postoperative corneal endothelial cell loss was 18.6%, in PHACO group, the rate was 18.5%; in SICS group, the rate was 19.0%, the difference of which was no significant (chi(2)=0.102, P>0.05). The surgery time was different in two groups. No severe complications occurred. CONCLUSION: Both Phaco and SICS combined with IOL implantation for aged patients are effective and safe. Before surgery, detailed physical examination should be performed. When the systemic condition is stable, cataract surgery for aged patients is safe.

Small-incision lenticule extraction versus femtosecond lenticule extraction for myopic:a systematic review and Meta-analysis

AIM： To examine differences in efficacy, accuracy, safety, aberrations and corneal biomechanical between Small incision lenticule extraction （SMILE） and femtosecond lenticule extraction （FLEx） for myopia. METHODS： Comprehensive studies were conducted on the PubMed, MEDLINE, EMBASE, and Cochrane Controlled Trials Register before 31 July, 2015. Meta-analyses were performed on the primary outcomes [loss of ≥2 lines of corrected distance visual acuity （CDVA）, uncorrected distance visual acuity （UDVA） ≥20/20, spherical equivalent （SE） within ±0.50 diopters （D）, final refractive SE], secondary outcomes were high-order aberrations （HOAs） and corneal biomechanical [central corneal thickness （CCT）, corneal hysteresis （CH） and corneal resistance factor （CRF）]. RESULTS： Seven trials describing a total of 320 eyes with myopia were included in this Meta-analysis. No significant differences were found in the efficacy [UDVA weighted mean difference （WMD） -0.01; 95%CI： -0.04 to 0.01; P=0.37, UDVA ≥20/20, OR 1.49; 95%CI： 0.78 to 2.86; P=0.23], accuracy （SE WMD -0.03; 95%CI： -0.12 to 0.07; P=0.58 , SE within ±0.5 D OR 1.25; 95%CI： 0.34 to 4.65; P=0.74）, HOAs （WMD -0.04; 95%CI： -0.09 to 0.01; P=0.14） and CCT WMD 1.83; 95%CI： -7.07 to 10.72; P=0.69, CH WMD -0.01; 95%CI： -0.42 to 0.40; P=0.97, CRF WMD 0.17; 95%CI： -0.33 to 0.67; P=0.50） in the last fellow-up. But for safety, FLEx may achieve fewer CDVA lost two or more two lines （OR 11.11; 95%CI： 1.27 to 96.86; P=0.03） than SMILE, however CDVA （WMD 0.00; 95%CI： -0.03 to 0.02; P=0.77） is similar. CONCLUSION： SMILE and FLEx are comparable in terms of both efficacy, accuracy, aberrations and corneal biomechanical measures in the follow-up,but FLEx seems to be better in safety measures. The results should be interpreted cautiously since relevant evidence is still limited, although it is accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.

Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering

AIM： To investigate cap morphology after small-incision lenticule extraction （SMILE） and its effects on intraocular scattering. METHODS： Sixty-five eyes of 33 patients undergoing SMILE were enrolled. In addition to regular evaluation, Fourier-domain optical coherence tomography was used to investigate cap thickness at ld, lwk, 1 and 3mo postoperatively. The optical quality including modulation transfer function cutoff frequency, Strehl ratio, Optical Quality Analysis System （OQAS） values, and objective scattering index （OSI）, were evaluated using OQASTM. RESULTS： Cap thickness decreased from ld to lwk （P〈0.001）, but remained higher than intended thickness of 120 μm after 3mo （P〈0.001）. Cap thickness in central area was thinner than that of in the paracentral and peripheral areas （P〈0.0001）. Total number of microdistortions decreased from ld to 3mo （P〈0.0001）. Pearson analysis revealed a weak correlation between OSI and standard deviation of cap thickness at ld and lmo, as well as between range of cap thickness and OSI at 1mo. No correlation was found between microdistortion and OSI, but a negative correlation existed between microdistortion and range at ld and lmoafter surgery. CONCLUSION： The corneal cap tends to be more accurate and regular with time lapse. Better cap morphology tends to contribute less intraocular scattering in the eyes undergoing SMILE.

Comparison of clinical outcome of small-incision lenticule intrastromal keratoplasty and FS-LASIK for correction of moderate and high hyperopia

AIM:To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty(s LIKE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK)for correction of moderate and high hyperopia.METHODS:A case-controlled clinical study was performed.Twenty right eyes of 20 moderate and high hyperopia patients underwent s LIKE(s LIKE group)and 22 right eyes of 22 moderate and high hyperopia patients underwent FS-LASIK(FS-LASIK group)were enrolled in this study from October 2015 to October 2017.Visual acuity,refractive error,corneal thickness,and keratometry were compared between the groups before and 1 y postoperatively.RESULTS:The postoperative uncorrected near visual acuity(UNVA)and uncorrected distance visual acuity(UDVA)were improved in the two groups.The UNVA reached J1 in 15 eyes(75.0%)in the s LIKE group and 5 eyes(22.7%)in the FS-LASIK group 1 y after surgery(χ2=11.476,P=0.001).The UDVA was equal or better than the preoperative CDVA in 16 eyes(80.0%)in the s LIKE group and 8 eyes(36.4%)in the FS-LASIK group,respectively(X2=8.145,P=0.004).No eyes lost any line of best-corrected visual acuity(BCVA)in either group.The amount of postoperative residual hyperopia in the s LIKE group was significantly less than in the FS-LASIK group(Z=-2.841,P=0.004).The postoperative keratometry and corneal thickness were significantly higher in the s LIKE group than in the FS-LASIK group(t=4.411,10.279,P<0.001).The SRI and SAI of the s LIKE group were significantly higher than that in the FS-LASIK group.There was no statistically significant difference in mean decentration between the two groups.CONCLUSION:s LIKE has better visual and refractive outcome than FS-LASIK for correction of moderate and high hyperopia.

Visual outcome of manual small-incision cataract surgery:comparison of modified Blumenthal and Ruit techniques

AIM:To compare the efficacy and visual results of the modified Blumenthal and Ruit techniques for manual small-incision cataract surgery(MSICS).· METHODS:This was a prospective,non-randomized comparison of 129 patients with senile cataracts scheduled to undergo routine cataract surgery via either a superior scleral tunnel incision,i.e.,the Blumenthal technique(group 1,n = 64) or a temporal scleral tunnel incision,i.e.,the Ruit technique(group 2,n =65).MSICS and intraocular lens implantation were performed through an unsutured 6.5-to 7.0-mm scleral tunnel incision.Uncorrected and corrected visual acuity,intraoperative and postoperative complications,and surgically induced astigmatism calculated by simple subtraction were compared.Patients were examined at 1 day,1 week,1 month,and 3 months after surgery.· RESULTS:Both groups achieved good visual outcome with minor complications.Three months after surgery,the corrected visual acuity was 0.73 in the Blumenthal group and 0.69 in the Ruit group(P =0.29).The average(SD) postoperative astigmatism was 0.87(0.62) diopter(D) for the Blumenthal group and 0.86(0.62) D for the Ruit group.The mean(SD) surgically induced astigmatism was 0.55(0.45) D and 0.50(0.44) D for the Blumenthal and Ruit groups,respectively(P =0.52).Common complications were minimal hyphema and corneal edema.There was no statistically significant difference in the complication rate between the groups(P >0.05).· CONCLUSION:In MSICS,both the Blumenthal and Ruit techniques achieved good visual outcomes,with low complication rates.

Incidence and risk factors for vitreous loss in residents performing manual small-incision cataract surgery

AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery(MSICS). METHODS: The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. RESULTS: The mean age of the participants at the time of surgery was 68.42±2.05 y. Of the 490 patients, 250 patients were male, and 240 patients were female(P=0.23). A total of 215(43.9%) eyes had mature white cataract, 185(37.8%) eyes had brown cataract, and 90(18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2%(10/490). Vitreous loss occurred during hydrodissection [1/10(10%)], nucleus delivery [3/10(30%)], irrigation and aspiration [5/10(50%)], and intraocular lens insertion [1/10(10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio(OR)=3.99;P=0.02], irrigation and aspiration of cortical material(OR=3.07;P=0.03), and anterior capsular extension(OR=3.22, P=0.03) as independent risk factors for vitreous loss. CONCLUSION: Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.

Delayed diffuse lamellar keratitis after small-incision lenticule extraction related to immunoglobulin A nephropathy:A case report

BACKGROUND Diffuse lamellar keratitis(DLK)is a complication of laser-assisted in situ keratomileusis(LASIK).This condition can also develop after small-incision lenticule extraction(SMILE)with a distinctive appearance.We report the case involving a female patient with delayed onset DLK accompanied by immunoglobulin A(IgA)nephropathy.CASE SUMMARY A 22-year-old woman was referred to our department for DLK and a decline in vision 1 mo after undergoing SMILE.The initial examination showed grade 2 DLK in the flap involving the central visual axis of the right eye.She was immediately administered with a large dose of a topical steroid for 30 d.However,the treatment was ineffective.Her vision deteriorated from 10/20 to 6/20,and DLK gradually worsened from grade 2 to 4.Eventually,interface washout was performed,after which her vision improved.DLK completely disappeared 2 mo after washout.Six months after SMILE,the patient was diagnosed with IgA nephropathy due to a 4-year history of interstitial hematuria.CONCLUSION DLK is a typical complication of LASIK but can also develop after SMILE.Topical steroid therapy was ineffective in our patient,and interface washout was required.IgA nephropathy could be one of the factors contributing to the development of delayed DLK after SMILE.

胆囊功能的新认识

胆囊的功能是浓缩和储存胆汁,由于胆囊结石等疾病的高发病率,胆囊切除术已成为最常见的外科手术之一.尽管对于多数患者来说,胆囊切除术是一种成功的治疗,但胆囊功能的丧失也可能导致慢性腹泻及近端结肠癌、胰腺癌、肝细胞癌、食管腺癌发病率升高等问题.随着内镜技术的发展和防止胆囊结石复发药物的使用,保胆取石术已成为治疗胆囊结石的另一种选择.这种手术方式在治疗胆囊结石的同时也保留了胆囊的功能,而这也可能可以避免因胆囊功能丧失所导致的问题.

TVP加膀胱切开取石术治疗前列腺增生伴膀胱结石

采用经尿道前列腺电气化（TVP）加膀胱切开取石术治疗Ⅰ～Ⅱ度良性前列腺增生症（BPH）伴多发性或直径较大、质地坚硬的单个膀胱结石14例，结果取出膀胱结石1～18枚；平均手术时间95min，均未输血；术后5～7d拔除导尿管，均排尿通畅。认为TVP加膀胱切开取石术与传统的耻骨上前列腺切除术（SPP）加膀胱取石术相比，具有出血少、创伤小、并发症少、康复快及住院时间短等优点，是一种安全高效的手术方式。

经尿道前列腺剜除联合耻骨小切口治疗重度前列腺增生并膀胱多发结石

目的探讨经尿道前列腺剜除联合小切口治疗重度前列腺增生并膀胱多发结石的临床意义。方法回顾性分析自2009年1月～2011年2月收治的14例重度前列腺增生并膀胱多发结石患者行经尿道前列腺剜除联合小切口取出前列腺剜除标本与多发结石的临床资料。结果手术时间为52～93分钟,术后患者血尿持续时间3.5d(1～5d),术中出血量30～110ml,均未输血,无水中毒及循环负荷过重。术后膀胱冲洗时间3.1d(1～5d),耻骨后引流管48～72小时拔除,术后7～9天拔除尿管,切口均甲级愈合。拔除尿管后,患者无明显尿频/尿急、排尿困难、尿路感染,无永久性尿失禁。结论采取经尿道前列腺剜除联合小切口取出剜除前列腺与多发结石的方法治疗重度前列腺增生并膀胱多发结石患者,手术时间短,痛苦少,恢复快。

西藏地方性膀胱结石患儿一例并文献复习

目的探讨西藏地方性膀胱结石的防治方法。方法分析l例西藏地方性膀胱结石患儿的临床资料，记录体质量，评估营养状况。并在文献复习的基础上对其临床表现、影像学检查、实验室检查、诊断治疗方法及可能预防措施进行讨论。结果患儿轻度营养不良，2枚膀胱结石最大径分别为2．0及1．5cm，经膀胱切开取石术治愈，排尿中断的症状消失。随访8周无结石残留及复发。结论地方性膀胱结石是一种少见疾病。诊断主要依靠超声检查、腹部X线平片，有时需要借助CT扫描。对边远地区患儿及较大、多发膀胱结石患儿及膀胱容量≤50ml患儿可选择膀胱切开取石术，其优点是操作简单、手术时间短、净石率高。改善膳食结构、纠正营养不良可能预防原发性地方性膀胱结石发生。

经皮膀胱肾镜治疗小儿膀胱结石

目的：探讨经皮膀胱肾镜碎石术在小儿膀胱结石中的应用。方法：对15例小儿膀胱结石患者的临床治疗资料进行回顾性分析。其中患儿年龄4~9（6.6±1.57）岁,膀胱结石直径1.3~3.7（2.6±0.92）cm;行耻骨上膀胱穿刺建立经皮膀胱通道,用钬激光或气压弹道击碎膀胱结石,视术中情况留置尿管。结果：所有患儿均获手术成功,手术时间20~45（32.5±6.43）min。术后早期5例患儿因留置尿管感尿道疼痛,无明显严重并发症出现。随访6~12个月,所有患儿均排尿通畅,无尿道狭窄和结石复发。结论：经皮膀胱肾镜治疗小儿膀胱结石具有安全、有效,结石清除率高等优点,可有效避免经尿道手术所致的术中技术风险、术后结石残留和尿道狭窄。

双极等离子电切联合下腹部小切口治疗前列腺增生症并发巨大膀胱结石34例

目的：探讨治疗前列腺增生症（ BPH）并发巨大膀胱结石的有效方法。方法回顾分析34例采用经尿道等离子前列腺电切（ TPKRP）联合下腹部小切口膀胱切开取石术治疗BPH并发巨大膀胱结石的临床资料。结果全组34例均顺利完成手术，等离子前列腺电切50～108 min，平均72 min。耻骨上膀胱切开取石20～45 min，平均38 min。术中出血量约150～250 ml，平均215 ml，未出现严重并发症病例。随访2～24个月，术后国际前列腺症状评分（IPSS）平均6．6分，生活质量评分（QOL）平均1．8分，平均尿流率（AFR）13．8 ml／s。结论双极等离子电切联合下腹部小切口治疗BPH并发巨大膀胱结石是一种安全、高效、低费用的术式，适合基层医院推广应用。

腹腔镜下保胆取石术治疗胆囊结石24例临床观察

目的观察腹腔镜下保胆取石术治疗胆囊结石的疗效。方法笔者所在医院胆囊结石患者中,选取24例行腹腔镜下保胆取石术患者作为观察组,24例行开腹保胆取石术患者为对照组,对比观察其疗效。结果观察组患者的手术时间、住院费用、术后的排气时间和住院时间都明显高于对照组患者(P<0.05),观察组并发症也少于对照组。结论腹腔镜下保胆取石具有创伤小、疼痛轻、胃肠功能恢复快以及并发症少等优点。医生加强训练,熟练掌握腹腔内缝合打结技术,能有效降低手术时间,使腹腔镜下保胆取石术得到更广泛推广。

Efficacy, safety, predictability, aberrations and corneal biomechnical parameters after SMILE and FLEx: Metaanalysis

AIM： To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction（SMILE） and femtosecond lenticule extraction（FLEx）.· METHODS： A systematic literature retrieval was conducted in Medline,Embase and the Cochrane Library up to October, 2015. The included studies were subject to a Meta-analysis. Comparison between SMILE and FLEx was measured as pooled odds ratio（OR） or weighted mean differences（WMD）. Of 95% confidence intervals（CI） were used to analyze data.·RESULTS： A total of seven studies were included Firstly, there were no differences in uncorrected distance visual acuity（UDVA） 20/20 or better（OR, 1.37; 95% CI0.69 to 2.69; P =0.37） and log MAR UDVA（WMD,-0.02;95% CI,-0.05 to 0.01; P =0.17） after SMILE versus FLEx We found no differences in corrected distance visua acuity（CDVA） unchanged（OR, 0.98; 95% CI, 0.46 to 2.11;P =0.97） and log MAR CDVA（WMD,-0.00; 95% CI,-0.01 to 0.01; P =0.90） either. Secondly, we found no differences in refraction within ±1.00 D（OR, 0.98; 95% CI0.13 to 7.28; P =0.99） and ±0.50 D（OR, 1.62; 95% CI0.62 to 4.28; P =0.33） of target postoperatively. Thirdly for higher-order aberrations, we found no differences in the total higher-order aberrations（WMD,-0.04; 95%CI,-0.09 to 0.01;P =0.14）, coma（WMD,-0.04; 95% CI,-0.09 to 0.01; P =0.11）, spherical（WMD, 0.01; 95% CI,-0.02 to0.03; P =0.60） and trefoil（WMD,-0.00; 95% CI,-0.04 to0.03; P =0.76）. Furthermore, for corneal biomechanica parameters, we also found no differences（WMD, 0.08;95% CI,-0.17 to 0.33; P =0.54） after SMILE versus FLEx.·CONCLUSION： There are no statistically differences in efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters postoperative between SMILE and FLEx.

Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.

经尿道前列腺电切术联合小切口膀胱取石术治疗前列腺增生症合并膀胱结石的效果观察

目的评价经尿道前列腺电切术联合小切口膀胱取石术治疗前列腺增生症合并膀胱结石的临床疗效。方法选择2010年12月~2012年12月我院确诊并收治的80例前列腺增生症并发膀胱结石患者,采用随机数字表法将其分为两组,其中行开放性手术治疗的30例为对照组;行经尿道前列腺电切术联合小切口膀胱取石术的30例为实验组。比较两组结石清除情况、各观察指标,包括IPSS评分、最大尿流率、并发症发生率、术后导尿管留置时间及住院时间等。结果 80例患者手术均成功,结石清除率为100.0%,无残留问题发生;实验组患者的IPSS评分、并发症发生率低于对照组,术后导尿管留置时间及住院时间均明显短于对照组,最大尿流率显著高于对照组,两组比较差异有统计学意义（P〈0.05）。结论经尿道前列腺电切术联合小切口膀胱取石术治疗前列腺增生症合并膀胱结石较开放性手术结石清除率无明显差异,但能明显缓解前列腺增生症状,同时还具有创伤小、恢复快、并发症少等优势,可作为首选治疗方案在临床推广应用。

Urolithiasis: Diagnostic and Therapeutic Aspects in Urology Department of N’Djamena in Chad

Introduction: To study the clinical, paraclinical, diagnostic aspects and manage patients with urolithiasis according to the available technical facilities in urology department of N’Djamena in Chad. Urolithiasis is defined as the presence of one or more stony concretions located at any level of a segment of the urinary tract: calyx, renal pelvis, ureters, bladder and urethra. Materials and Methods: This was a descriptive type of a prospective study over a period of 4 years, from January 2008 to December 2011, involving 233 patients with urolithiasis treated in the urology department. Clinical and paraclinical examinations were the basis for the selection of patients. Informed consent of patient or their parents (for minors) was obtained for the anonymous use of records and photographs for scientific aims. Results: Urolithiasis represented 5.72% (233/4072) of all urological pathologies. Male dominance was significant with a sex ratio of 4.5/1. The age group of 0 - 10 years was the most affected with a staff of 67 (28.75%). The clinic was dominated by dysuria (44.63%), renal colic (33.91%) and hematuria (9.01%). The main anatomical location was bladder (62.23%). The management was essentially medical and surgical. We recorded 7 cases of death or post-interventional hospital mortality rate of 3%. Conclusion: Urolithiasis is a real public health problem in Chad. Due to the inadequacy of the technical platform, the management was based on the open surgery. Etiological research was impossible by lack of technical laboratory platform.

大于10cm膀胱结石1例报告并文献复习

目的:探讨大于10cm膀胱结石的病因、首选辅助检查及治疗方法。方法:回顾性分析1例大于10cm膀胱结石患者的临床资料:因尿频20年余,伴尿痛1周入院。B超检查显示膀胱壁增厚,回声增强,其内见11cm×10cm强光团伴声影;KUB见膀胱区有12cm×10cm团状高密度影。在连续硬膜外麻醉下行膀胱切开取石术。并结合文献复习予以讨论。结果:术后测结石体积为12cm×12cm×11cm,重量为1 025g,呈黄棕色,质地较硬,表面呈分层结构。结石成分分析为草酸钙和尿酸混合型结石。患者术后恢复良好。结论:大于10cm膀胱结石十分罕见。X线检查应作为首选辅助检查方法;治疗宜采用耻骨上膀胱切开取石术。

前列腺剜除术联合小切口膀胱切开术治疗大体积前列腺增生并膀胱结石的疗效观察

目的：探讨＂半微创技术＂即经尿道2μm激光前列腺剜除术联合小切口膀胱切开术,治疗大体积良性前列腺增生（BPH）合并大体积或多发膀胱结石的疗效。方法：对21例大体积BPH合并膀胱结石患者,采用经尿道2μm激光剜除前列腺,后经耻骨上正中切口显露膀胱,将所剜除腺体及结石取出。结果：21例手术均成功,手术时间明显缩短,患者均未输血。术后4~6d拔除尿管。术前与术后6个月Qmax分别为（6.1±2.6）ml/s和（20.5±4.3）ml/s;剩余尿分别为（125.7±61.5）ml与（19.0±5.8）ml;国际前列腺症状评分（IPSS）分别为（21.6±5.2）分与（5.4±3.0）分;生活质量评分（QOL）分别为（4.3±0.5）分与（1.9±0.8）分。四项指标手术前后比较差异均有统计学意义（P〈0.01）。术后随访3~6个月,2例出现暂时性尿失禁,全部患者无尿瘘、切口感染等手术并发症。结论：经尿道2μm激光前列腺剜除术结合小切口膀胱切开术,一次性治疗大体积BPH合并多发膀胱结石能明显减少手术时间,具有安全、高效的优点,对于大体积BPH合并膀胱多发结石或质硬、直径〉3cm结石的高龄患者值得推荐应用。