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目的研究在低压CO_2气膀胱的条件下行经尿道膀胱结石大力碎石钳碎石术治疗的安全性及高效性。方法将2012年3月至2015年3月我科收治的75例膀胱结石患者随机分组,分别采用传统膀胱灌注液体(37例)和低压CO+2气膀胱条件下(38例)行经尿道碎石钳碎石术治疗,比较分析两组病例的膀胱黏膜损伤例数、膀胱壁损伤例数、导尿管留置时间等安全性指标及碎石时间、结石残留情况(是或否)等有效性指标。结果经尿道低压CO2+气膀胱下膀胱结石碎石术组患者38例,碎石时间(7.57±5.57)min,膀胱黏膜出血1例,膀胱壁损伤0例,中转开放手术0例,术后留置尿管时间平均(6.57±2.87)d,术后结石残留1例,残留结石直径1mm(沙粒样)。经尿道膀胱灌注生理盐水条件下膀胱结石碎石术组患者37例,平均碎石时间(27.62±16.71)min,膀胱黏膜出血17例,膀胱壁损伤5例,膀胱壁穿孔中转开放手术修补1例,术后留置尿管时间平均(8.16±3.12)d,术后结石残留5例,残留结石直径3~5mm。两组病例有效性及安全性指标数据比较,差异有显著性统计学意义(P<0.05)。结论与传统膀胱灌注生理盐水相比,低压CO_2气膀胱法下经尿道大力碎石钳碎石术视野清晰,可有效减少碎石钳对膀胱黏膜的副损伤,安全性更高,碎石效率显著提高。
Objective To study the safety and efficacy of transurethral mastectomy and lithotripsy of bladder stones under the condition of low pressure CO_2 bladder. Methods Seventy-five patients with bladder stones admitted to our department from March 2012 to March 2015 were randomly divided into two groups: the conventional intravesical instillation fluid (37 cases) and the low-pressure CO + 2 air bladder condition (38 cases) Pliers lithotripsy treatment, comparative analysis of two groups of cases of bladder mucosal injury cases, the number of cases of bladder wall injury, urinary catheter retention time and other safety indicators and gravel time, residual stone (yes or no) and other indicators of effectiveness . Results Thirty-eight cases were treated with transurethral low pressure CO2 + bladder calculi and stones, 7.57 ± 5.57 min in gravel, 1 in bladder mucosa, 0 in bladder wall, 0 in open surgery, The mean time of tube was (6.57 ± 2.87) d, residual stone was found in 1 case and residual stone was 1 mm in diameter (gritty). 37 patients with bladder lithotripsy undergoing transurethral intravesical instillation of saline in the bladder were treated by transplanting the bladder wall by perforation in 1 case (37 cases), the average time of lithotripsy (27.62 ± 16.71) min, the hemorrhage of bladder mucosa in 17 cases, the bladder wall injury in 5 cases, (8.16 ± 3.12) d, postoperative residual stones in 5 cases, residual stones 3 ~ 5mm in diameter. There was significant difference between the two groups in the validity and safety index data (P <0.05). Conclusions Compared with the traditional bladder irrigation with saline, the clear urethral lithotripsy under the low-pressure CO_2 air bladder method can effectively reduce the side injury of the bladder mucosa by the lithotripter, which is more safe and effective in lithotripsy improve.