等离子电切镜在尿道狭窄合并膀胱结石治疗中的应用  

Application of Plasmakinetic Resectoscope in the Treatment of Urethrostenosis Complicated with Bladder Stones

作　　者：彭明栋 李思熳[2] 陈永生 唐文广 鞠海宇 王诚 孙林 王剑松[3] 

机构地区：[1]云南九洲医院泌尿外科,云南昆明650224 [2]昆明医科大学生物化学与分子生物学系,云南昆明650500 [3]昆明医科大学第二附属医院泌尿外科,云南昆明650032

出　　处：《昆明医科大学学报》2014年第8期60-62,共3页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81160302);云南省科技厅应用基础研究基金资助项目(2011FZ109)

摘　　要：目的 探讨等离子电切镜在尿道狭窄合并膀胱结石治疗中的安全性和有效性.方法 连续硬膜外麻醉或腰硬联合麻醉下用F26等离子电切镜直视下检查尿道狭窄情况,将F3输尿管导管或斑马导丝通过等离子电切镜柱状电极操作鞘通道经狭窄段尿道置入或其它方式作引导直至输尿管导管或斑马导丝进入膀胱,再用等离子柱状电极通过操作鞘通道将狭窄段瘢痕切开,最后改用等离子电切环行瘢痕等离子电切直至电切镜进入膀胱,最后也通过同一通道连接气压弹道碎石设备碎石,将碎石用ELLICK冲洗出,留置尿管2～6周,拔管后定期行尿道扩张.结果 所有患者手术均成功,术后复查无结石残留无并发症出现.结论 采用等离子电切镜治疗尿道狭窄合并膀胱结石安全、有效,值得临床推广、应用.Objective To investigate the safety and efficacy of plasmakinetic resectoscope in the treatment of urethrostenosis complicated with bladder stones.Methods Urethrostenosis was explored by F26 plasmakinetic resectoscope under direct vision in the state of combined spinal-epidural anesthesia （CSEA）.An F3 ureteral catheter or a Zebra urologic guidewire was placed in the bladder via the stricture of the urethra.Patients with severe urethrostenosis were appropriately guided by injection of methylene blue through cystostomy or insertion of a cystoscope with lamphouse and a metal divulsor into the stricture.An incision was then made in cicatrices of the stricture by a cylindrical electrode （PLASMA-CISETM ＆ PLASMA-CUTTM） via the operating sheath channel,followed by plasmakinetic resection of the cicatrices with a resectoscope loop till the resectoscope reached the bladder,and finally the pneumatic lithotripsy through the same channel.The broken stones were flushed out with ELLICK,and a Foley catheter was indwelt for two to six weeks.Regular urethral extensions were performed following Foley catheter removal.Results Urination was markedly improved in all patients following Foley catheter removal compared with pretreatment.Urination was smooth during postoperative urethral extensions without complications.Conclusion Plasmakinetic resectoscope is advantageous in the treatment of urethrostenosis complicated with bladder stones,and it is safe and effective and deserves clinical generalization.

关 键 词：尿道狭窄 膀胱结石 等离子电切镜 气压弹道碎石术 

分 类 号：R694.4[医药卫生—泌尿科学]