经尿道输尿管镜下第三代碎石清石系统治疗婴儿膀胱结石及尿道结石合并急性尿潴留  

EMS through ureteroscope per urethra for the treatment of infant bladder and urethral stone with acute urinary retention

作　　者：李文辉[1] 张伟[1] 马文强[1] 李伟文[1] 闫红英[1] 路媛[1] 郎晓玲[1] 孙颖浩(点评) 

机构地区：[1]解放军第一医院泌尿外科,郑州730030 [2]不详

出　　处：《中华泌尿外科杂志》2008年第11期733-735,共3页Chinese Journal of Urology

摘　　要：目的评价经尿道输尿管镜下第三代碎石清石系统（EMS）治疗婴儿膀胱结石及尿道结石合并急性尿潴留的疗效。方法应用输尿管镜下EMS治疗三聚氰胺所致膀胱结石及尿道结石合并急性尿潴留患儿10例。男9例，女1例。平均年龄9个月。膀胱结石2例，尿道结石8例，结石直径0．5～1．1cm，平均0．8cm。全麻下行经尿道输尿管镜下碎石清石术，采用Wolf 8．0～9．8F输尿管镜，在电视监视下，从输尿管镜操作通道伸入EMS超声碎石探针将膀胱结石及尿道结石完全粉碎吸出，术中膀胱内保持50～100ml液体，灌注泵压力为160～210kPa（1kPa=10．20cmH2O），平均180kPa，超声碎石能量40％～60％，占空比30％～70％，平均60％。术后留置8F双腔气囊导尿管。结果10例平均手术时间25min，均将尿道结石冲入膀胱，在输尿管镜下一次性清除结石，麻醉清醒后拔除导尿管，均能立即顺利排尿。3d后复查B超，膀胱、尿道内均无残留结石。结论对婴儿膀胱结石及尿道结石合并急性尿潴留患儿，应用输尿管镜下EMS清除结石，可以立即解除下尿路梗阻，恢复正常排尿，具有安全、高效、损伤小的优点，可作为膀胱结石及尿道结石合并急性尿潴留患儿手术解除下尿路梗阻的首选方法。Objective To evaluate the effect of EMS through ureteroscope per urethra for the treatment of infant bladder and urethral stone with acute urinary retention. Methods Ten cases （9 boys, 1 girl）of infant bladder and urethral stone with acute urinary retention were treated by EMS through ureteroscope per urethra. Mean age of the patients was 9 months. Two cases suffered from bladder stones while the other 8 cases suffered from urethral stones. The size of stones varied from 0.5- 1.1 cm with the average of 0.8 cm. All 10 cases underwent EMS through ureteroscope per urethra after general anaesthesia by using ketamine in vein. Wolf F8/9.8 ureteroscope was used and monitored by television. The EMS probe of ultrasound lithotripsy was sticked through operating passway of ureteroscope to shatter and eliminate bladder and urethral stone. During operation, 50- 100 ml liquid pressure was retained in the urinary bladder. The pressure of perfusion pump varied between 160 and 210 kPa（average, 180 kPa）. The energy of ultrasound lithotripsy was 40% - 60 % with a ratio of 30%-70%. F8 type of 2 cavity aerocyst urethral catheter was indwelled after operation. Results The average operation time was 25 min. Urethral stones were rinsed into bladder. Stones were elimi nated at one time by ureteroscope. Urethral catheters were removed after the patients revived from anesthesia and smooth urination was seen immediately after operation. No retained calculus in thebladder and urethra was found by B ultrasound 3 days later. Conclusions Low urinary obstruction could be relieved immediately after EMS through ureteroscope per urethra in patients of infant bladder and urethral stone with acute urinary retention. This operation is safe, high-efficient with less lesion, and would be the first option for the patients of infant bladder and urethral stone with acute urinary re tention.

关 键 词：婴儿 输尿管镜 膀胱结石 尿道结石 碎石术 三聚氰胺 

分 类 号：R699[医药卫生—泌尿科学]