超声引导下经皮耻骨上膀胱穿刺造瘘术的应用

Application of ultrasound-guided percutaneous suprapubic cystostomy

目的探讨超声引导下经皮耻骨上膀胱穿刺造瘘术在复杂性病例中的应用。方法根据术前评估结果,将膀胱穿刺造瘘患者分为两组:低危组(A组,38例)和高危组(B组,30例)。B组病例包括肥胖、挛缩性小膀胱、既往盆腔手术病史及前列腺重度突入膀胱等情况。A组采用传统的盲穿法,B组采用超声引导下的Seldinger技术。比较两组手术时间、疼痛视觉模拟评分量表评分及手术并发症等指标。结果 A组平均手术时间[(7.5±1.4)min]显著短于B组[(13.0±3.0)min](P=0.000)。A组术后即刻疼痛评分(4.5±0.9)高于B组(4.0±0.9)(P=0.02);术后30 min疼痛评分(2.9±0.9)亦高于B组(1.7±0.7)(P=0.000)。两组患者术中及术后均无重大并发症发生,轻微并发症的发生率A组高于B组(21.1%vs.3.3%,P=0.000)。结论超声引导下经皮耻骨上膀胱穿刺造瘘术穿刺准确率高且创伤小,为高风险患者提供了一种安全、有效的手术方式。

Objective To present our experience of the technique of ultrasound-guided percutaneous suprapubic cystostomy(PSC) in complex urological cases.Methods A prospective study was done of 68 patients for suprapubic cystostomy.For our analyses,the patients were divided into two groups accoding to the risk of complications: 38 patients in the low-risk group(group A) and 30 patients in the high-risk group(group B).The cases in group B included patients with marked obesity,decompressed bladders,previous abdominal surgery and severe intravesical prostatic protrusion.A traditional blind approach was conducted in group A,while ultrasound-guided Seldinger technique was applied in Group B.Comparative analysis was carried out between the two groups examining operative times,visual analog scale pain scores and operative complications.Results Mean operative times were(7.5±1.4) min in group A versus(13.0±3.0) min in group B(P=0.000).The average pain score was 4.5±0.9 in groups A versus 4.0±0.9 in groups B at the conclusion of the procedure(P=0.02).The average pain score was 2.9±0.9 in groups A versus 1.7±0.7 in groups B at 30 min after the procedure(P=0.000).PSC was successful in all the patients at the first attempt.There were no seveve complications reported.Complication rate in group A was higher than that in group B(21.1% vs.3.3%,P=0.000).Conclusions Ultrasound-guided PSC is a safe and efficient procedure when the blind approach is deemed with increased risk of failure or complications.