微创经皮膀胱取石术治疗膀胱结石86例报告

Minimally invasive percutaneous cystolithotripsy in the treatment of bladder stones:Report of 86 cases

目的探讨微创经皮膀胱取石术治疗膀胱结石的可行性及相关疗效。方法我院自2005年6月至2011年4月采用微创经皮膀胱取石术治疗膀胱结石86例。其中成人患者79例,小儿患者7例;男性患者83例,女性患者3例;年龄最大者88岁,最小者2岁。麻醉显效后患者取平卧位,耻骨上2 cm处穿刺入膀胱,建立经皮膀胱通道,留置工作鞘。经鞘置入输尿管镜,行气压弹道碎石,碎石片从鞘中钳取出或冲洗出。术毕缝合穿刺口皮肤,留置导尿。结果 86例手术均获成功,无残余结石,无膀胱穿孔及明显出血,术后排尿通畅,原有尿道狭窄患者无加重,也无新的尿道狭窄发生。结论微创经皮膀胱取石术治疗膀胱结石具有创伤小、恢复快、清石率高、并发症少、安全及操作简单等优点,可有选择性的在临床开展。

Objective To evaluate the feasibility and efficacy of minimally invasive percutaneous cystolithotripsy in the treatment of bladder stones. Methods From June 2005 to April 2011, a total of 86 patients （79 adults and 7 pediatrics, 83 males and 3 females, age 2-88 years）with bladder stones underwent minimally invasive percutaneous cystolithotripsy. Patients were put in a supine position after anesthesia. A skin bladder channel created by the fascia expanders was established 2 cm above the suprapubic region, then the work sheath was indwelled. Ureteroscope was put in through the sheath, then stones were crushed with pneumatic lithotripsy and removed from the channel by clipping and flushing. After surgery, sutured the incision of skin, indwelling catheter. Results All of the 86 patients were operated successfully. No residual stones, no bladder perforation, no obvious bleeding, and no difficulty in urinating were observed. The original urethral stricture patients didn＇t become heavier, no new urethral stricture occurred. Conclu- sions According to our experience, minimally invasive pereutaneous cystolithotripsy is an effective therapy in the treatment of patients with bladder stones which has less trauma, quick recovery, high stone removal rate, less complications, safety and simple operation. It is suitable for promotion in clinical.