经皮肾镜气压弹道联合钬激光碎石治疗复杂性上尿路结石

目的 探讨经皮肾镜气压弹道联合钬激光碎石对复杂性上尿路结石的治疗效果.方法 对218例复杂性上尿路结石患者采用经皮肾镜气压弹道联合钬激光碎石治疗的疗效结果进行回顾性分析.结果 218例患者均一次性穿刺成功建立碎石通道,其中162例采用气压弹道联合钬激光碎石,34例单独采用钬激光碎石,22例单独采用气压弹道碎石;182例患者I期手术结石清除干净(结石清除率83.5％),24例有小直径结石残余,12例择期行mPCNL二期手术;术中术后均未出现明显的并发症.结论 经皮肾镜下钬激光联合气压弹道碎石术治疗复杂上尿路结石,具有安全性好、结石清除率高、并发症少等优点.     

输尿管镜气压弹道碎石术与经皮肾穿刺钬激光碎石术治疗输尿管上段结石临床疗效分析

目的探讨输尿管镜气压弹道碎石术与经皮肾穿刺钬激光碎石术两种手术方式治疗输尿管上段结石的临床疗效。方法选取2010年1月~2012年12月我院收治的输尿管上段结石患者126例进行随机分组,输尿管镜气压弹道组64例,经皮肾穿刺钬激光组62例。结果气压弹道组的手术时间为(45.30±3.20)min,明显长于钬激光组(28.61±2.13)min,差异有统计学意义(P0.001);两组患者术后住院时间差异无统计学意义(P0.05)。气压弹道组的术后出血量为(31.53±6.24)ml,明显多于钬激光组(16.16±3.13)ml,差异有统计学意义(P0.001)。术后3d复查结石清除情况,气压弹道组结石清除率70.31%,低于钬激光组85.48%,差异有统计学意义(P0.05);术后1个月复查结石清除情况,气压弹道组结石清除率78.13%,低于钬激光组95.16%,差异有统计学意义(P0.05);术后气压弹道组并发症发生率29.69%,高于钬激光组24.19%,差异无统计学意义(P0.05)。结论超声引导经皮肾穿刺钬激光碎石术治疗输尿管上段结石效果良好,具有手术时间短、结石清除率高、并发症少等优点,值得临床上进一步研究和推广应用。     

气压弹道碎石术与钬激光碎石术治疗输尿管结石的比较

目的：比较经输尿管镜气压弹道碎石术与钬激光石术治疗输尿结石的疗效和安全性。方法：总结应用输尿管镜技术治疗285例尿管结石患者的临床资料,其中气压弹道碎石术145例,钬激光碎石术140例。结果钬激光碎石术单次手术碎石率为95．75,高于气压弹道碎石术的69．7％,P＜0．01;钬激光碎石术平均结石排净时间为18d,短于气压弹道碎石术的31d,P＜0．01;钬激光碎石组无明显并发症发生,气压弹道碎石组有5例发生穿孔。结论钬激光碎石术的有效率和安全性优于气压弹碎石术,钬激光碎石术是治疗输尿管结石的一种安全、有高效的方法。     

输尿管镜气压弹道与钬激光碎石治疗输尿管结石的临床分析

目的探讨输尿管镜气压弹道与钬激光碎石术治疗输尿管结石的临床疗效。方法回顾性分析我院自2003年1月至2010年12月采用输尿管镜气压弹道碎石治疗输尿管结石301例,钬激光碎石治疗输尿管结石114例的临床资料,比较其碎石效果、手术时间、术后住院时间及并发症发生率等。结果气压弹道碎石一次性粉碎率为98．0％（295／301）,一次性取净率为90．7％（273/301）,一侧手术平均时间56．7±15．2min,术后平均住院时间6.8±2.3d;钬激光碎石一次性粉碎率为99．1％（113/114）,一次性取净率为90．4％（103／114）,一侧手术平均时间47．4±13．7min,术后平均住院时间4．3±1．9d。两组均未见输尿管穿孔等并发症。钬激光碎石组手术平均时间及术后平均住院时间明显少于气压弹道碎石组。结石清除率无显著差异。结论输尿管镜气压弹道与钬激光碎石两种方式治疗输尿管结石均安全有效,但钬激光碎石效率更高,术后恢复更快。     

三种微创碎石术治疗复杂性输尿管上段结石的临床对比研究

目的:探讨经皮肾镜、经尿道输尿管镜气压弹道碎石术及经尿道输尿管镜钬激光碎石术治疗复杂性输尿管上段结石的临床疗效及安全性。方法:选取150例复杂性输尿管上段结石患者,随机分为A组、B组及C组,每组50例,分别行经皮肾镜、经尿道输尿管镜气压弹道碎石术及经尿道输尿管镜钬激光碎石术。对比3组患者手术时间、术后血红蛋白减少值、住院时间、一次性结石清除率、二次手术率、手术前后患侧肾脏肾小球滤过率水平、术后并发症发生率等。结果:A组手术时间显著短于B、C组(P0.05);B、C组患者术后血红蛋白减少值、住院时间均显著优于A组(P0.05);3组患者一次性结石清除率、二次手术率及术后患侧肾脏肾小球滤过率水平差异无统计学意义(P0.05);C组患者术后并发症发生率显著低于A、B组(P0.05)。结论:相较经皮肾镜、经尿道输尿管镜气压弹道碎石术,经尿道输尿管镜钬激光碎石术治疗复杂性输尿管上段结石可有效减少术中创伤、加快术后康复进程,并有助于降低术后并发症发生风险。     

钬激光碎石术与气压弹道碎石术治疗胆道术后残余结石临床比较

目的比较钬激光碎石术与气压弹道碎石术治疗胆道术后残余结石的临床疗效。方法使用钬激光碎石治疗85例胆道术后残余结石患者;气压弹道碎石术治疗85例胆道术后残余结石患者。结果85例使用钬激光碎石治疗的患者一次手术结石粉碎率为96.4%,平均手术时间为25min。而气压弹道碎石组中上述各项指标分别为78.8%;平均手术时间为49min,均与钬激光碎石组有明显差异。结论钬激光碎石效明显优于气压弹道碎石,是治疗胆道术后残余结石一种安全、有效的碎石方法。     

输尿管镜钬激光碎石与气压弹道碎石的比较

目的：比较输尿管镜下钬激光碎石术与气压弹道碎石术治疗输尿管结石的疗效与安全性。方法：回顾性分析输尿管镜下治疗76例输尿管结石患者的临床资料，其中采用钬激光碎石治疗36例（钬激光组）．气压弹道碎石治疗40例（气压弹道组）。结果：钬激光组平均术中碎石时间为8min，明显短于气压弹道组15min（P〈0．01）。钬激光组碎石成功率为97．2％，明显高于气压弹道碎石组的87．5％（P〈0．01）。两组手术均较安全，无明显相关并发症出现。结论：钬激光碎石术的有效性优于气压弹道碎石术，是一种治疗输尿管结石安全、高效的方法。     

钬激光碎石术治疗输尿管上段结石110例

目的观察经尿道钬激光碎石术治疗输尿管上段结石的临床疗效及安全性。方法利用VersapulseSelect钬激光机经输尿管肾镜治疗110例输尿管上段结石病人,并以130例接受气压弹道碎石术的病人作为对照。结果110例输尿管结石患者一次手术结石粉碎率为96.4%(106例),平均结石排净时间2.5周;平均手术时间和术后住院天数分别为22min及2d。术中无输尿管穿孔、撕裂等并发症。而气压弹道碎石组中上述各项指标分别为86.9%3.1周、4.5min和5d,均与钬激光组有明显差异。结论钬激光碎石是治疗泌尿系结石一种安全、有效的腔道泌尿外科碎石方法。     

大功率钬激光碎石术与气压弹道碎石术治疗肾结石的疗效比较

目的：比较经皮肾微穿刺造瘘（MPCN）大功率钬激光碎石术与气压弹道碎石术治疗肾结石的有效性和安全性。方法：回顾性分析我院自2003年6月～2005年8月使用MPCN大功率（30～60w）钬激光碎石术与气压弹道碎石术治疗肾结石患者87例94侧的临床资料,比较两种碎石方法的碎石时间、结石排净率、并发症发生率、平均单侧碎石费用等指标的差异。结果：钬激光组39侧患肾,气压弹道组55侧患肾。钬激光组平均碎石取石时间77min（41～134min）,低于气压弹道组89min（46～142min）。钬激光组Ⅰ期治疗结石排净率为79％,Ⅱ期治疗后结石总排净率为86％;气压弹道组Ⅰ期治疗结石排净率为75％,Ⅱ期治疗后结石总排净率为83％。尿液转清平均时间钬激光组为40h,低于气压弹道组平均时间58h。手术并发症发生率钬激光组为4％,低于气压弹道组7％。术后平均血红蛋白下降钬激光组为5．1％,低于气压弹道组7．3％。平均单侧碎石机费用钬激光组为5000元,高于气压弹道组300元。结论：MPCN大功率钬激光碎石术较气压弹道碎石术碎石时间短,效率高,手术并发症低,是治疗包括巨大铸形结石在内的各种肾结石的有效方法,但费用较高。     

完全无管化经皮肾镜钬激光碎石术治疗上尿路结石42例

目的探讨完全无管化经皮肾镜钬激光碎石取石术治疗上尿路结石的可行性及疗效。方法 2014年1月~2015年7月对42例上尿路结石B超引导下行微通道经皮肾镜钬激光碎石取石术,不留置肾造瘘管和双J管,观察手术时间、出血量、留置尿管时间、术后住院时间、结石清除率和并发症等。结果 42例均一期建立经皮肾镜微通道,钬激光碎石,均未留置肾造瘘管及双J管,无大出血或周围脏器损伤等严重并发症发生,无中转开放手术。手术时间30~110 min,(54.8±25.1)min;术中出血量20~150 ml,(44.5±18.5)ml;术后留置尿管3~5 d,(3.7±0.9)d;术后住院3~7 d,(4.0±1.0)d。术后复查KUB提示4例有小结石残留,无须特殊处理。42例随访3个月,均无继发大出血或严重感染等并发症发生。结论严格选择病例实施完全无管化PCNL是安全可行的,未增加术后相关并发症风险,完全有可能成为一些肾镜手术的选择方式。     

Endoscopic lithotripsy with the holmium:YAG laser

BACKGROUND AND OBJECTIVE: The holmium:YAG (Ho:YAG) laser can be used not only for soft tissue but also for hard tissue such as urinary calculi. The objective of this study was to assess the usefulness of the Ho:YAG laser for endoscopic lithotripsy in patients with urinary tract stone. STUDY DESIGN/MATERIASL AND METHODS: Of 102 procedures performed among 96 patients, 88 were transurethral ureterolithotripsy (TUL), seven were percutaneous nephrolithotripsy, and seven were transurethral cystolithotripsy. Six patients had bilateral stones. The fragments were reduced as much as possible with the Ho:YAG laser. RESULTS: The efficacy rate of the 102 lithotripsy procedures was 93%. With respect to the effect of TUL, the efficacy rates of 40 procedures for the proximal ureter, 18 procedures for the midureter, and 30 procedures for the distal ureter were 85%, 94%, and 100%, respectively. CONCLUSION: The Ho:YAG laser produced a sufficiently strong lithotripsy force on all stones. The results of this study indicate that lithotripsy of urinary tract stones with the Ho:YAG laser can achieve a clinical outcome equivalent to or exceeding that of pulsed dye laser lithotripsy. The Ho:YAG laser is a multipurpose laser and thus is a cost effective and very useful means for endoscopic lithotripsy of urinary tract stones.     

Comparison of pneumatic and Holmium laser ureteroscopic lithotripsy for upper third ureteral stones

ObjectiveTo evaluate the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter and Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper third ureteral stones.Materials and methodsPatients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper third ureteral stones were retrospectively reviewed. Patients with urinary tract infection, radiolucent stones, loss of follow-up, concurrent middle or lower third ureteral stones or acute renal failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups.ResultsThere were 158 patients with 178 upper third ureteral stones (135 in pneumatic lithotripsy group and 43 in Ho:YAG laser lithotripsy group) meeting the study criteria. Patients' age, gender, stone laterality, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less secondary intervention rate as compared with pneumatic lithotripsy (53.4% vs. 40.1%; 72.1% vs. 91.9%; 25% vs. 48.5% respectively, all p < 0.05). In patients with stones larger than 10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate.ConclusionsHo:YAG laser lithotripsy is superior to pneumatic lithotripsy in the management of upper third ureteral stones in terms of double J stent insertion rate, stone free rate and secondary intervention rate for stones of all sizes. For stones larger than 10 mm, laser lithotripsy results in less stone upward migration.     

AH-1型取石系统经尿道膀胱碎石的疗效评估

目的 评估AH-1型取石系统(SRS系统)治疗膀胱结石的安全性和疗效.方法 采用SRS系统经尿道碎石+经尿道前列腺电切术(TURP)治疗的膀胱结石伴前列腺增生(BPH)74例结石患者,与经尿道输尿管镜碎石+TURP治疗的50例结石患者的临床资料进行回顾性比较.直径＜2 cm和≥2 cm结石分别评估.结果 SRS组＜2 cm结石直径大于对照组(P＜0.001).二组相比,＜2 cm结石患者的总手术时间和结石清除时间均少于对照组(P＜0.02,P＜0.001).单发性≥2 cm结石患者的总手术时间和结石清除时间差异有显著性(P＜0.05).≥2 cm结石组清除一枚结石所需平均手术时间差异有统计学意义(P＜0.001).SRS系统组无严重并发症发生.结论 SRS系统可提供固定结石、提供碎石通道、自动收集碎石、摄取碎石、冲吸碎石和连续冲洗等功能.尤其是可固定结石、自动收集碎石、一次可摄取多枚碎石.这样可缩短手术时间,拓展内镜治疗膀胱结石的手术适应范围.其联合TURP用于治疗膀胱结石伴BPH是一种安全、有效的治疗方法.     

Percutaneous suprapubic cystolithotripsy for treatment of large bladder calculi

BACKGROUND AND PURPOSE: The treatment options available for managing bladder calculi include transurethral cystolithotripsy, open cystolithotomy, and shockwave lithotripsy. For larger calculi, transurethral treatment can be time consuming, and the manipulation has the potential to cause urethral injury. Percutaneous suprapubic cystolithotripsy represents another treatment option for bladder calculi which is effective and minimally invasive. PATIENTS AND METHODS: Fifteen patients had bladder calculi treated with percutaneous cystolithotripsy over a 3-year period. The mean stone size was 39 mm (range 10-64 mm). Stones were single in seven patients and multiple in eight patients. The indications for cystolithotripsy were stone size >3 cm, multiple stones >1 cm, and inability to perform transurethral cystolithotripsy because of patient anatomy. Percutaneous suprapubic cystolithotripsy was done through either a 30F or a 36F cystotomy tract. Fragmentation and removal was performed with a 26F rigid nephroscope and the pneumatic Swiss Lithoclast. Suprapubic and urethral catheters were placed postoperatively in all patients. RESULTS: Each patient was cleared of the stone burden with a single procedure, and there were no major complications. The mean duration of suprapubic catheterization was 2.6 (range 1-5) days. CONCLUSION: Percutaneous suprapubic cystolithotripsy is an effective and safe technique for treating large bladder calculi. It is minimally invasive, avoids urethral injury, and, in combination with the pneumatic Swiss Lithoclast, can be used to fragment and remove large and hard bladder calculi.     

输尿管镜气压弹导碎石术治疗儿童下尿路结石

目的：探讨儿童下尿路结石的治疗方法。方法：应用输尿管镜气压弹导碎石术经尿道或膀胱穿刺造瘘通道治疗儿童下尿路结石22例。结果：22例均一次成功击碎结石，治愈率100％。其中2例经膀胱穿刺造瘘通道碎石，术中即将结石取净。20例经尿道膀胱内碎石，术后结石均排净。无一例有并发症。结论：输尿管镜下气压弹导碎石治疗儿童下尿路结石，创伤小，成功率高，并发症少，为一种较理想的治疗方法。     

三种腔内微创方法在前列腺增生并膀胱结石的疗效比较

目的：比较经尿道大力碎石钳、气压弹道碎石和钬激光在BPH合并膀胱结石患者中碎石的疗效和安全性。方法：把BPH合并膀胱结石165例分为三组：Ⅰ组68例用大力碎石钳碎石后联合经尿道前列腺电切治疗;Ⅱ组51例经尿道气压弹道碎石后联合经尿道前列腺汽化电切治疗;Ⅲ组46例经尿道钬激光碎石后联合经尿道前列腺等离子双极电切治疗,对3组术中、术后并发症及碎石效果进行比较。结果：Ⅰ组术中发生前列腺或膀胱损伤、穿孔19例,因膀胱穿孔或结石无法粉碎改为开放手术23例,术后发生尿道狭窄9例,碎石成功率为62.0%（42/68）;Ⅱ组碎石成功率为80.0%（41/51）,其中5例术中发生膀胱损伤、穿孔,因结石无法粉碎转为开放手术7例,术后发生尿道狭窄3例; Ⅲ组无术中并发症,46例全部碎石成功（46/46）,术后6月发生尿道外口狭窄1例。三组之间的碎石成功率、术中并发症发生率、转开放手术率比较差异均有显著性（P<0.05）。结论：经尿道钬激光碎石联合经尿道前列腺等离子双极电切治疗BPH并膀胱结石是一种安全、高效的方法,可以作为首选。     

Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined

IntroductionControversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary.MethodsPatients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence.ResultsPatients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07–1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p=0.04) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due to the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking.ConclusionsA simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.     

钬激光腔内治疗泌尿系结石(附126例报告)

目的：探讨泌尿系结石腔内钬激光治疗效果及安全性。方法：总结钬激光结合腔内泌尿外科技术治疗126例泌尿系结石的临床资料。结果：5例肾结石和11例膀胱结石，均一次碎石成功，109例输尿管结石，单次碎石率为96.3%(105/109)，复杂结石1例数次行输尿管腔镜下碎石。平均结石排净时间2.8周，平均手术时间30min，平均术后住院2d。术中除1例输尿管穿孔外，无其他并发症。结论：钬激光结合腔内泌尿外科技术治疗泌尿系结石，是一种较新的、安全的、有效的方法。     

经尿道前列腺汽化电切联合钬激光碎石治疗前列腺增生合并膀胱结石

目的探讨前列腺汽化电切(TUVP)和钬激光同期治疗前列腺增生合并膀胱结石的疗效及安全性。方法总结24例前列腺增生合并膀胱结石患者,应用钬激光经尿道膀胱镜粉碎膀胱结石并同期行TUVP的临床资料。结果24例患者中,膀胱结石均一次碎石成功,碎石后行TUVP,无膀胱结石残留、膀胱穿孔及水中毒发生,手术时间62~160min,平均手术时间88 min,切除前列腺质量20~120 g,平均38 g,术后平均拔除尿管时间3~6 d,平均4.75 d,平均住院时间10 d,所有患者术后均排尿通畅,无尿失禁。结论TUVP和钬激光同期治疗前列腺增生合并膀胱结石是一种安全有效的治疗方法,具有损伤小、结石清除率高、并发症少等优点。     

TURP联合肾镜下弹道超声波碎石清石术治疗前列腺增生并发膀胱结石(附43例报告)

目的:探讨一期腔内治疗BPH并发膀胱结石的有效治疗方法.方法:采用TURP联合肾镜下气压弹道及超声碎石清石术治疗BPH并发膀胱结石43例.结果:43例均一次手术成功,无输血,无膀胱穿孔、TURP综合征及严重感染等并发症发生.术后复查KUB,膀胱内均未见结石残留,清石率达100%.住院5～7天.最大尿流率较术前明显改善.结论:TURP联合肾镜下气压弹道及超声碎石清石术治疗BPH并发膀胱结石,创伤小,恢复快,安全高效,是治疗BPH并发膀胱结石的理想方法.