Teichman J M, Rogenes V J, McIver B J, Harris J M
Division of Urology, University of Texas Health Science Center, San Antonio 78284-7845, USA.
Urology. 1997 Jul;50(1):44-8. doi: 10.1016/S0090-4295(97)00201-X.
Patients with large bladder calculi (4 cm or larger) have traditionally been managed with open cystolithotomy. Endoscopic management with cystolitholapaxy or electrohydraulic lithotripsy risks complications. In an effort to spare patients the morbidity of open cystolithotomy, the results of holmium:yttrium-aluminum-garnet (YAG) laser cystolithotripsy for bladder calculi 4 cm or larger were reviewed.
Consecutive patients with bladder calculi of 4 cm or larger were managed with holmium:YAG laser cystolithotripsy. Laser energy was delivered using either the 365-micron end-firing fiber or the 550-micron side-firing fiber.
Fourteen consecutive patients were managed with holmium:YAG cystolithotripsy. All patients were rendered stone free, regardless of stone composition or size. Median anesthesia time was 57 minutes. Twelve of 14 patients were discharged by the first postoperative day. The procedure times normalized for stone size (mean +/- standard deviation) for the end-firing versus the side-firing fibers were 13 +/- 6 min/cm versus 6 +/- 1 min/cm, respectively; P = 0.04.
Holmium:YAG laser cystolithotripsy of large bladder calculi is effective, technically facile, and safe. The 550-micron side-firing fiber may be better suited for large bladder calculi compared with the 365-micron end-firing fiber. Holmium:YAG cystolithotripsy may obviate open cystolithotomy in selected patients.
传统上，膀胱结石较大（4厘米或更大）的患者采用开放性膀胱切开取石术治疗。采用膀胱碎石术或电液压碎石术进行内镜治疗有并发症风险。为使患者免受开放性膀胱切开取石术的发病之苦，我们回顾了钬：钇铝石榴石（YAG）激光膀胱碎石术治疗4厘米或更大膀胱结石的结果。
对连续的膀胱结石4厘米或更大的患者采用钬：YAG激光膀胱碎石术治疗。使用365微米端射光纤或550微米侧射光纤输送激光能量。
连续14例患者接受了钬：YAG膀胱碎石术治疗。所有患者结石均被清除，无论结石成分或大小如何。中位麻醉时间为57分钟。14例患者中有12例在术后第一天出院。端射光纤与侧射光纤针对结石大小归一化后的手术时间（平均值±标准差）分别为13±6分钟/厘米和6±1分钟/厘米；P = 0.04。
钬：YAG激光膀胱碎石术治疗大膀胱结石有效、技术操作简便且安全。与365微米端射光纤相比，550微米侧射光纤可能更适合大膀胱结石。钬：YAG膀胱碎石术可能使部分患者无需进行开放性膀胱切开取石术。
