经尿道肾镜下气压弹道联合超声碎石清石术治疗膀胱结石

目的探讨经尿道肾镜下气压弹道联合超声碎石清石术治疗膀胱结石的疗效。方法2005年10月～2008年5月,膀胱结石69例（男63例,女6例）,结石直径1.5～6.0 cm,其中合并前列腺增生55例,神经源性膀胱14例,膀胱憩室结石4例。经尿道置入Wolf F20.8肾镜,采用瑞士EMS公司第3代气压弹道联合超声碎石清石系统治疗膀胱结石69例。气压弹道频率调至8～12 Hz,超声能量设定为50%～60%。合并前列腺增生应用前列腺汽化电切术。结果68例一次碎石、清石成功,手术时间15～40 min,平均25 min。1例膀胱憩室结石术中出现膀胱破裂,改行开放手术。无一例出现尿道狭窄、感染、大出血等严重并发症。68例随访6～10个月,平均9个月,B超或X线腹部平片检查未见结石复发。结论经尿道肾镜下气压弹道联合超声碎石清石术治疗膀胱结石疗效满意。

Transurethral Nephroscopic Pneumatic Lithotripsy Combined with Ultrasound Lithotripsy for Bladder Calculus

Objective To explore the efficacy of transurethral nephroscopic pneumatic lithotripsy combined with ultrasound lithotripsy for bladder calculus. Methods By using transurethral F20.8 nephroscope and EMS LithoCaster, we performed transurethral nephroscopic pneumatic lithotripsy and ultrasound lithotripsy on 69 patients with bladder calculus （63 men and 6 women） between October 2005 and May 2008. The diameter of the calculi was ranged from 1.5 to 6.0 cm. Among the patients, 42 had one stone in the bladder, while 27 had multiple calculi. Fifty-five patients were complicated with BPH, 14 had neurogenic bladder, and 4 showed bladder diverticulum with stones in situ. Pneumatic frequency was set at 8 -12 Hz, and ultrasonic energy was 50% -60%. For the patients with BPH electrovaporization ablation was plused. Results Among the 69 patients, 68 were cured in one session. The mean operation time was 25 minutes （ 15 to 40 minutes）. One patient was converted to open surgery because of rupture of the bladder during the procedure. No patient had urethral stricture, infection, or massive hemorrhage during the operation. Follow-up was available in 68 patients for 6 to 10 months （mean, 9 months）. During the period, no recurrent calculi was found by uhrasonography and X-ray. Conclusion Transurethral nephroscopic pneumatic lithotripsy combined with ultrasound lithotripsy is effective for bladder calculus.