3D打印激光工作鞘在膀胱结石碎石术中的应用  

Application of 3D-printed Laser Working Shealth in the Lithotripsy of Bladder Calculi

作　　者：曹贵华 李伟[1] 杜建平[1] 黄贵闽[1] 刘亮程 李强 Cao Guihua;Li Wei;Du Jianping(Department of Urology, People’s Hospital of Leshan, Leshan 614000, China)

机构地区：[1]乐山市人民医院泌尿外科,乐山614000

出　　处：《中国微创外科杂志》2021年第9期805-808,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：四川省医学会课题(S18045)。

摘　　要：目的探讨3D打印激光工作鞘在膀胱结石碎石术中的安全性和有效性。方法2019年9月~2020年10月我科对25例膀胱结石(合并前列腺增生10例),采用3D打印制作的激光工作鞘与F21膀胱镜外鞘相连接后,经激光工作鞘的光纤通道插入钬激光光纤行经尿道或经皮膀胱通道钬激光碎石术,碎石能量设定20~40 W。10例合并前列腺增生行常规绿激光前列腺汽化术。结果25例手术均成功完成,术中视野清晰,流入道和流出道水流通畅,膀胱无过度充盈和空虚。碎石时间15~60 min,平均35 min。术后10例膀胱冲洗时间6~24 h,平均12 h;15例未行膀胱冲洗。术后3~5 d拔除尿管,均无发热、尿外渗、排尿困难、尿失禁等发生。1例小儿患者行经皮膀胱通道钬激光碎石取石,术中未留置膀胱造瘘管,术后腹壁切口无尿外渗、出血。24例随访6个月,无排尿困难、尿失禁、逆行射精等。结论应用3D打印制作激光工作鞘处理膀胱结石微创、安全、有效。Objective To evaluate the safety and efficacy of 3D-printed laser working shealth in the treatment of bladder calculi.Methods From September 2019 to October 2020,25 cases of bladder calculi,including 10 cases of bladder claculi combined with benign prostatic hyperplasia(BPH),were enrolled.Holmium laser lithotripsy through the urethra or percutaneous bladder channel was performed by using a 3D-printed laser working sheath which connected with the outer sheath of F21 cystoscope.The power setting for lithotripsy was 20-40 W.The 10 cases combined with BPH underwent routine green laser vaporization of the prostate.Results All the operations were successfully completed.The vision of surgical field was clear during the operation,the inflow tract and outflow tract were free of water,and the bladder was not overfilled or empty.The time of lithotripsy was 15-60 min(mean,35 min)and the mean postoperative bladder irrigation time was 12 h(range,6-24 h)except for 15 cases without bladder irrigation.The urethral catheter was withdrawn at 3-5 d.No fever,urinary infiltration,dysuria,or incontinence occurred.One case of child underwent the lithotripsy through the percutaneous bladder channel.No bladder fistula was left during the operation,and there was no urine extravasation or bleeding in the abdominal incision after the operation.A total of 24 cases were followed up for 6 months and no dysuria,urinary incontinence,or retrograde ejaculation was noted.Conclusion Application of 3D-printed laser working shealth is minimally invasive,safe,and effective in the treatment of bladder calculi.

关 键 词：3D打印 激光工作鞘 膀胱结石 

分 类 号：R69[医药卫生—泌尿科学]