两种微创手术治疗较大膀胱结石的疗效比较

Comparison of two minimally invasive surgical treatments for large bladder stone

目的比较两种微创手术疗法对较大膀胱结石(直径≥2.5 cm)疗效,探讨经皮膀胱造口治疗较大膀胱结石的优势。方法对我院收治的80例膀胱结石患者(结石直径≥2.5 cm)的临床资料进行回顾性分析,根据治疗方法分为经皮组和经尿道组,每组40例。经皮组采用经皮膀胱造口气压弹道碎石术进行治疗,经尿道组采用经尿道气压弹道碎石术进行治疗,对比分析两组疗效。结果与经尿道组相比,经皮组在手术时间、置管时间、排尿症状消失时间等方面,优于经尿道组;在出血量方面,经皮组少于经尿道组,差异均有统计学意义(P<0.01)。经皮组的一期清石率为97.5%,经尿道组的一期清石率为85%;经皮组总有效率为92.5%,经尿道组总有效率为75%,经皮组一期清石率和总有效率均高于经尿道组,差异有统计学意义(P<0.05)。结论与经尿道气压弹道碎石术相比,经皮膀胱造口气压弹道碎石术治疗直径≥2.5 cm膀胱结石的疗效更优,此法值得推广应用。

Objective To compare the clinical effect of two different minimally invasive surgical treatments for patients with larger bladder stones （ diameter 2.5 cm or above） , and to explore the advantages of minimally invasive percutaneous transurethral cystostomy in the treatment of larger bladder stones. Methods The clinical data of 80 patients with bladder stones （ above 2.5 cm in diameter） were retrospectively analyzed. According to the treatment, 40 patients were divided into the percutaneous group and transure- thral group respectively. 〈 〈 〈 In the percutaneous group, percutaneous cystostomy combined with pneumatic lithotfipsy was used while in the transurethral group, transurethral pneumaticlithotripsy was performed. The clinical efficacy was compared and analyzed between the two groups 〉 〉 〉. Results The percutaneous group was superior to the transurethral group in terms of operation time, catheterization time and voiding time. The amount of bleeding loss was smaller in the percutaneous group than in the transurethral group （P 〈0.01 ）. The first-stage stone clearance rate was 97.5% in the percutaneous group and 85% in the transurethral group. The total effective rate was 92. 5% in the transcutaneous group （ P 〈 0. 05 ）, higher than in the transurethral group （ P 〈 0. 05 ）. Conclusions Percutaneous pneumatic lithotripsy is more effective for the treatment of bladder stones with a diameter of 2.5 cm or above than transurethral pneumatic lithotripsy, and this method is worthy of popularization and application in clinical practice.