改良经电切镜外鞘气压弹道碎石术治疗老年膀胱结石的效果(1)
[摘要]目的 研究改良经电切镜外鞘气压弹道碎石术对老年膀胱结石患者的临床效果。方法 选择2016年4月～2017年4月我院收治的102例膀胱结石患者为观察对象。以随机数字表法分为观察组和对照组，各51例。对照组实施肾镜下气压弹道碎石术治疗，观察组实施改良经电切镜外鞘辅助肾镜下气压弹道碎石术治疗。对比两组的疗效及结石清除率、并发症发生情况。结果 观察组手术时间及住院时间均明显短于对照组，术后止痛药剂量少于对照组，术后3 d外周血炎症因子TNF-α及CRP水平均明显高于对照组，差异有统计学意义(P<0.01)；两组患者术前VAS及VRS评分差异无统计学意义(P>0.05)；术后VAS及VRS评分均明显低于对照组；两组患者的并发症发生率差异无统计学意义(P>0.05)。结论 改良经电切镜外鞘辅助肾镜下气压弹道碎石术治疗老年膀胱结石患者，其疗效优于肾镜下气压弹道碎石术，值得应用。
[关键词]电切镜；气压弹道碎石术；膀胱结石
[中图分类号] R699 [文献标识码] A [文章编号] 1674-4721(2017)10(a)-0095-03
[Abstract]Objective To study the clinical effect of modified external sheath pneumatic ballistic lithotripsy via resectoscope in the treatment of elderly bladder stones.Methods 102 patients with bladder stones who were admitted to our hospital from April 2016 to April 2017 were selected as the observation subjects.They were randomly divided into observation group and control group according to the random number table，with 51 patients in each group.The control group was given pneumatic ballistic lithotripsy under nephroscope，and the observation group was given modified external sheath-assisted pneumatic ballistic lithotripsy under nephroscope via resectoscope.The efficacy，the removal rate of stones，and complications were compared between the two groups.Results The operation time and length of hospital stay were significantly shorter in the observation group than those in the control group，the postoperative analgesic dose was less than that in the control group，the levels of inflammatory factors in the peripheral blood such as TNF-α and CRP 3 d after surgery were significantly higher than those in the control group，the differences were statistically significant (P<0.01)；there was no statistically significant difference in VAS and VRS scores between the two groups before operation (P>0.05)；postoperative VAS and VRS scores were significantly lower than those in the control group；there was no statistically significant difference in the incidence rate of complications between the two groups (P>0.05).Conclusion The efficacy of modified external sheath-assisted pneumatic ballistic lithotripsy under nephroscope via resectoscope in the treatment of elderly bladder stones is better than that in the pneumatic ballistic lithotripsy under nephroscope，which is worthy of application.
[Key words]Resectoscope；Pneumatic ballistic lithotripsy；Bladder stones
膀胱結石分为继发性和原发性两种。原发性膀胱结石多发于儿童，主要由营养不良所造成，但随着人们生活水平的提高，儿童原发性膀胱结石呈逐年下降的趋势[1]。而继发性膀胱结石多见于中老年男性，通常是由于上或下尿路出现感染、梗阻神经源性膀胱或膀胱异物等因素所致，是泌尿系统常见疾病[2]。其在临床具有较典型的疼痛、排尿中断及血尿症状。B超等常规检查能准确诊断，主要治疗手段依靠于手术。膀胱结石直径超过5 cm患者可采取传统耻骨上经膀胱切开术，缺点为创伤大，术后恢复慢[3]。随着外科微创技术的高速发展，临床广泛采用肾镜下弹道碎石术，该术疗效虽然显著却因肾镜在较小的男性尿道使得操作受限，存在尿道受损风险。本研究探讨了改良经电切镜外鞘辅助肾镜下气压弹道碎石术对老年患者的治疗效果。, http://www.100md.com(桑海明 郭祯远 孙云)
[关键词]电切镜；气压弹道碎石术；膀胱结石
[中图分类号] R699 [文献标识码] A [文章编号] 1674-4721(2017)10(a)-0095-03
[Abstract]Objective To study the clinical effect of modified external sheath pneumatic ballistic lithotripsy via resectoscope in the treatment of elderly bladder stones.Methods 102 patients with bladder stones who were admitted to our hospital from April 2016 to April 2017 were selected as the observation subjects.They were randomly divided into observation group and control group according to the random number table，with 51 patients in each group.The control group was given pneumatic ballistic lithotripsy under nephroscope，and the observation group was given modified external sheath-assisted pneumatic ballistic lithotripsy under nephroscope via resectoscope.The efficacy，the removal rate of stones，and complications were compared between the two groups.Results The operation time and length of hospital stay were significantly shorter in the observation group than those in the control group，the postoperative analgesic dose was less than that in the control group，the levels of inflammatory factors in the peripheral blood such as TNF-α and CRP 3 d after surgery were significantly higher than those in the control group，the differences were statistically significant (P<0.01)；there was no statistically significant difference in VAS and VRS scores between the two groups before operation (P>0.05)；postoperative VAS and VRS scores were significantly lower than those in the control group；there was no statistically significant difference in the incidence rate of complications between the two groups (P>0.05).Conclusion The efficacy of modified external sheath-assisted pneumatic ballistic lithotripsy under nephroscope via resectoscope in the treatment of elderly bladder stones is better than that in the pneumatic ballistic lithotripsy under nephroscope，which is worthy of application.
[Key words]Resectoscope；Pneumatic ballistic lithotripsy；Bladder stones
膀胱結石分为继发性和原发性两种。原发性膀胱结石多发于儿童，主要由营养不良所造成，但随着人们生活水平的提高，儿童原发性膀胱结石呈逐年下降的趋势[1]。而继发性膀胱结石多见于中老年男性，通常是由于上或下尿路出现感染、梗阻神经源性膀胱或膀胱异物等因素所致，是泌尿系统常见疾病[2]。其在临床具有较典型的疼痛、排尿中断及血尿症状。B超等常规检查能准确诊断，主要治疗手段依靠于手术。膀胱结石直径超过5 cm患者可采取传统耻骨上经膀胱切开术，缺点为创伤大，术后恢复慢[3]。随着外科微创技术的高速发展，临床广泛采用肾镜下弹道碎石术，该术疗效虽然显著却因肾镜在较小的男性尿道使得操作受限，存在尿道受损风险。本研究探讨了改良经电切镜外鞘辅助肾镜下气压弹道碎石术对老年患者的治疗效果。, http://www.100md.com(桑海明 郭祯远 孙云)