经尿道蓝激光治疗膀胱尿酸结石2例报告

Transurethral blue laser treatment of bladder stones: a report of 2 cases

摘要

目的 报道2例采用蓝激光治疗良性前列腺增生合并膀胱尿酸结石患者的临床资料，为该类结石的治疗提供参考。方法 回顾陕西汉中镇巴县人民医院泌尿外科成功实施蓝激光碎石术的2例良性前列腺增生合并膀胱尿酸结石患者的临床资料，对患者症状、病情特点、手术经过、治疗结果及并发症进行分析。结果 2例患者均以进行性排尿困难加重或血尿就诊，经B超和磁共振成像均确诊为膀胱结石及良性前列腺增生，患者2同时伴有膀胱腔内大量血凝块。对患者拟行经尿道蓝激光前列腺汽化术+经尿道膀胱结石钬激光碎石术，术中见2例患者的结石表面均为暗黄色，无明显孔隙，无细颗粒及棘刺样突起，尝试应用蓝激光（150 W）进行碎石，结石产生类似汽化的“烧蚀”现象，而后变小、碎裂。患者1、2碎石过程用时分别为11 min及8 min，但术中因结石不断漂移，均有多处膀胱黏膜损伤。2例患者的结石成分分析均提示为尿酸结石。随访3个月2例患者术后排尿通畅、控尿良好，结石无复发。结论 对于尿酸结石，可以尝试应用蓝激光进行碎石，碎石过程中应注意保护膀胱黏膜。

Abstract

Objective To report the clinical data of two patients with prostatic hyperplasia and bladder uric acid stones, so as to provide reference for clinical practice. Methods Clinical data of two patients successfully undergoing blue laser lithotripsy in Department of Urology, Zhenba County People's Hospital were retrospectively analyzed, including clinical manifestations, surgical methods, treatment outcomes and complications. Results Both patients sought medical care due to progressive dysuria or hematuria. B ultrasound and magnetic resonance imaging confirmed bladder calculi and prostatic hyperplasia. One patient also had large blood clots in the bladder cavity. Both patients received transurethral blue laser prostate vaporization + transurethral bladder stone holmium laser lithotripsy. The stone surface was dark yellow, with no obvious pores, fine particles or spike protrusion. Blue laser produced an “ablative” phenomenon similar to vaporization, and then stones became smaller and fragmented. The lithotripsy lasted for 11 min and 8 min, respectively. There were multiple bladder mucosal injuries due to constant drift of stones during operation. Stone composition analysis suggested uric acid stones. After 3 months of follow-up, both patients had smooth postoperative urination, good urine control, and no stone recurrence. Conclusion Blue laser can be applied to crush uric acid stones, and the bladder mucosa should be protected during lithotripsy.

关键词

蓝激光 / 膀胱结石 / 尿酸结石 / 经尿道手术 / 良性前列腺增生

Key words

blue laser / bladder stone / uric acid stone / transurethral surgery / benign prostatic hyperplasia

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