微通道经皮膀胱穿刺碎石术治疗老人和小儿膀胱结石的临床应用

Clinical application of minimally invasive percuteneous cystolithotripsy for geriatric and pediatric bladder stone

目的探讨微通道经皮膀胱穿刺碎石术治疗老人和小儿膀胱结石的安全性和可行性。方法2009年8月-2013年6月,我院采用微创经皮膀胱穿刺碎石术治疗老人和小儿膀胱结石患者21例,其中老年男性16例,小儿5例,结石直径0.9-3.0cm大小。经尿道置入导尿管,向膀胱内灌注生理盐水使膀胱充盈,于耻骨上1-2cm18G穿刺针穿刺膀胱,置入斑马导丝,沿导丝筋膜扩张器依次扩张通道至18-20F,留置peel-away套鞘,经套鞘置入输尿管镜,气压弹道击碎结石,碎石经套鞘冲出体外。术毕留置导尿管及膀胱造瘘管,术后3-5d拔除膀胱造瘘管,次日拔除导尿管。结果本组21例患者均手术顺利,手术时间20-65min,平均45min,出血少,一期清石率为100%。术后未发生明显并发症。随访3-18个月,无结石复发。结论微通道经皮膀胱穿刺碎石术治疗老人和小儿膀胱结石具有手术简便,损伤小,术后并发症少、出血少、手术时间短,结石清除率高等特点。

Objective To investigate the safety and feasibility of minimally invasive perentaneons cystolithotripsy for geriatric and pediatric bladder stone. Methods From Augest 2009 to June 2013,21 patients （16 geriatric,5 pediatric）with bladder stone underwent minimally invasive percutaneous eystoli-thotripsy. The stones size ranged from 9-30mm. Above suprapubie 1-2cm puncture into the bladder,insertion sheath expansion and along the guide wire followed by expansion to F18-F20 sheath,indwelling peel-away sheath. Endoscope was put into the bladder through the peel-away sheath,then stones were crushed with pneumatic and removed from the channel. After surgery,indwelling bladder fistula and catheter. A suprapubic catheter was removed for 3-5 days followed by the catheter 1 day later. Results All of 21 patients were operated successfully and became stonefree. Operation time was 20-65 min （average 45min）. No obvious complication occurred. During 3-18 months follow-up,no stone recurrence. Conclusion According to our experience, minimally invasive percutaneous cystolithotripsy is safe and effective therapy method in the treatment of geriatric and pediatric bladder stone which is less trauma, high stone removal rate, less complications, less blood loss and shorter operation time.