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目的:探讨EMS第四代混合动力碎石清石系统在巨大膀胱结石治疗中的应用。方法:对4例巨大膀胱结石应用EMS第四代混合动力碎石清石系统进行治疗。结石直径4.0～5.5 cm,平均4.3 cm。单发结石3例,多发结石1例。其中合并良性前列腺增生2例,神经源性膀胱1例。术前完善B超、KUB+IVU或CT等检查。腰麻/硬膜外麻,取膀胱截石位,经尿道置入Wolf 20.8 F肾镜,采用瑞士EMS公司第四代混合动力碎石清石系统治疗。气压弹道频率调至8～12 Hz,超声能量设定为50%～60%,将碎石探杆经镜鞘插入,质地较脆的结石,直接用超声将其击碎并吸出;否则先用气压弹道碎石,将其击成碎块后,再用超声碎石清石系统粉碎后吸出。合并良性前列腺增生者,结石取净后再行前列腺汽化电切术。结果:4例一次碎石、清石成功。手术时间45～160 min,平均85 min。单纯碎石者留置尿管1～2 d,同期行前列腺汽化电切者留置导尿5～6 d。无1例出现膀胱破裂、尿道狭窄、感染、大出血等并发症。随访3～8个月,无结石复发。结论:应用EMS第四代碎石清石系统治疗膀胱结石具有安全、损伤小、恢复快、住院时间短、结石清除率高、并发症少等优点,是治疗巨大膀胱结石的优选方法,值得临床应用。
Objective: To investigate the application of EMS fourth generation hybrid gravel stone system in the treatment of huge bladder stones. Methods: Four cases of huge cystolithiasis were treated with EMS fourth generation hybrid gravel stone system. Stone diameter 4.0 ~ 5.5 cm, an average of 4.3 cm. Single stone in 3 cases, multiple stones in 1 case. Including benign prostatic hyperplasia in 2 cases, 1 case of neurogenic bladder. Improve the preoperative B-ultrasound, KUB + IVU or CT and other tests. Spinal anesthesia / epidural anesthesia, bladder lithotomy position, transurethral placement of Wolf 20.8 F nephrolithotomy, Swiss EMS company using the fourth generation of hybrid gravel stone system treatment. Pneumatic ballistic frequency adjusted to 8 ~ 12 Hz, ultrasonic energy is set to 50% to 60%, the lithotripsy probe inserted through the sheath sheath, the texture of brittle stones, directly crushed and sucked out by ultrasound; Pneumatic lithotripsy, hit it into pieces, then crushed with ultrasonic gravel cleaning system sucked out. Benign benign prostatic hyperplasia who take the stone after the prostate vaporization resection. Results: 4 cases of gravel, stone success. Operation time 45 ~ 160 min, an average of 85 min. Pure lithotripsy indwelling catheter 1 ~ 2 d, the same period of prostate electrovaporization indwelling catheterization 5 ~ 6 d. No one case of bladder rupture, urethral stricture, infection, bleeding and other complications. Follow-up 3-8 months, no recurrence of stones. Conclusion: The treatment of cystolith with EMS 4th gravel system is a safe and effective method for the treatment of bladder stones. It is safe, less damaging, faster recovery, shorter hospital stay, high stone clearance rate and less complications. application.