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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 microchannel percutaneous bladder puncture lithotripsy in the treatment of bladder stones in the elderly and children. Methods From August 2009 to June 2013, 21 cases of bladder stones in the elderly and children were treated with minimally invasive percutaneous balloon puncture lithotripsy. Among them, 16 were elderly men, 5 were children, and the diameter of stones was 0.9-3.0 cm . Transurethral catheterization, intravesical instillation of saline to fill the bladder, the pubic bone 1-2cm18G puncture needle puncture the bladder, into the zebra guide wire, followed by guide wire fascia dilator channel expansion to 18-20F, Indwelling peel-away sheath sheath, the sheath sheath into the ureteroscopy, pneumatic ballistic crushing stones, lithotripsy sheath out of the body. After surgery, catheterization and bladder fistula catheterization, removal of bladder fistula 3-5d after surgery, removal of the catheter the next day. Results The 21 patients in this group were operated smoothly. The operation time was 20-65 minutes with an average of 45 minutes. The bleeding was less and the rate of the first stage was 100%. No significant postoperative complications. Follow-up 3-18 months, no recurrence of stones. Conclusion Micro-channel percutaneous cyst puncture lithotripsy for the treatment of bladder stones in elderly and pediatric patients has the advantages of simple operation, small injury, less postoperative complications, less bleeding, shorter operation time and higher stone clearance rate.