【摘要】 目的 研究F8单腔导尿管联合肾镜、钬激光碎石术治疗膀胱结石的临床效果。方法 60例膀胱结石(直径≤3 cm且数量≤5个)患者,按随机数字表法分为对照组(A组, n=20)和观察组(n=40),观察组再按随机数字表法分为B组(n=20)和C组(n=20)。A组采取肾镜+钬激光碎石术(钬激光功率设置为1.2～1.5 J/15～20 Hz)治疗, B组采取肾镜+电切镜鞘+钬激光碎石术(钬激光功率设置为1.2～1.5 J/15～20 Hz)治疗, C组采取肾镜+F8单腔导尿管+钬激光碎石术(钬激光功率设置为1.0～1.2 J/20～25 Hz)治疗。比较三组术中及术后情况(一次性碎石成功率、碎石时间、清石时间、尿道或膀胱黏膜损伤评分及术后导尿管留置时间)、术后并发症发生情况。结果 三组一次性碎石成功率均为100%,比较无统计学意义(P>0.05)。三组碎石时间、清石时间、尿道或膀胱黏膜损伤评分及术后导尿管留置时间比较差异均有统计学意义(P<0.05)。B组、C组碎石时间分别为(18.32±5.32)、(17.84±6.52)min,均短于A组的(25.42±7.30)min(P<0.05);B组、C组碎石时间比较无统计学意义(P>0.05)。B组清石时间(17.12±6.67)min、术后导尿管留置时间(2.30±0.21)d均短于A组的(24.38±8.10)min、(3.42±0.15)d(P<0.05);C组无需清石,术后导尿管留置时间短于A组、B组(P<0.05)。C组尿道或膀胱黏膜损伤评分(0.23±0.07)分均低于A组的(2.05±0.23)分、B组的(2.01±0.19)分(P<0.05);A组、B组尿道或膀胱黏膜损伤评分比较无统计学意义(P>0.05)。C组术后6个月内并发症发生率为0,低于B组的20%及A组的25%(P<0.05);A组、B组术后6个月内并发症发生率比较无统计学意义(P>0.05)。结论 F8单腔导尿管联合肾镜、钬激光碎石术(钬激光功率设置为1.0～1.2 J/20～25 Hz)治疗膀胱结石一次性碎石成功率高,且无需清石,手术时间更短,副损伤少,术后导尿管留置时间短,术后并发症发生率低,该技术安全有效,是值得临床上推广使用的一项技术。更多还原

【Abstract】 Objective To study the clinical effect of F8 single-lumen catheter combined with nephroscope and holmium laser lithotripsy in the treatment of bladder stones. Methods 60 patients with bladder stones(diameter ≤3 cm and quantity ≤5) were divided into a control group(group A, n=20) and an observation group(n=40) according to the random number table. The observation group was divided into group B(n=20) and group C(n=20) according to the random number table. Group A received nephroscope + holmium laser lithotripsy(holmium laser power set at 1.2-1.5 J/15-20 Hz), and group B received nephroscope + electrosurgical sheath +holmium laser lithotripsy(holmium laser power set at 1.2-1.5 J/15-20 Hz) and group C received nephroscopy + F8single-lumen catheter + holmium laser lithotripsy(holmium laser power set at 1.0-1.2 J/20-25 Hz). Comparison was made on the intraoperative and postoperative conditions(success rate of one-time lithotripsy, lithotripsy time, stone removal time, urethral or bladder mucosal injury score and postoperative catheter indwelling time),and the occurrence of postoperative complications in the three groups. Results The success rate of one-time lithotripsy was 100% in all three groups, and there was no statistical significance in comparison(P>0.05). There were statistically significant differences in lithotripsy time, stone removal time, urethral or bladder mucosal injury score and postoperative catheter indwelling time among the three groups(P<0.05). The lithotripsy time of group B and group C were(18.32±5.32) and(17.84±6.52) min, which was shorter than(25.42±7.30) min of group A(P<0.05). There was no statistical significance in the comparison of lithotripsy time between group B and group C(P>0.05). Group B had stone removal time of(17.12±6.67) min and postoperative catheter indwelling time of(2.30±0.21) d, which were shorter than(24.38±8.10) min and(3.42±0.15) d in group A(P<0.05). Group C did not need stone removal and had a shorter postoperative catheter indwelling time than that of group A and group B(P<0.05). The urethral or bladder mucosal injury score of group C was(0.23±0.07) points, which was lower than(2.05±0.23) points of group A and(2.01±0.19) points of group B(P<0.05). Comparison of urethral or bladder mucosal injury scores between group A and group B was not statistically significant(P>0.05). The complication rate within 6 months after surgery was 0 in group C, which was lower than 20% in group B and 25% in group A(P<0.05). Comparison of incidence of complications within 6 months after surgery between group A and group B was not statistically significant(P>0.05). Conclusion F8 single-lumen catheter combined with nephroscopic laser lithotripsy for bladder stones has a high success rate of one-time lithotripsy, and does not require stone removal. The operation time is shorter, there are less side injuries, and the postoperative catheter indwelling time is short. The incidence of complications is low, the technology is safe and effective, and is worthy of widely used in clinical practice.更多还原