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目的探讨微通道经皮膀胱取石术治疗小儿膀胱结石的可行性及临床疗效。方法2002年5月至2009年1月,采用微通道经皮膀胱取石术对16例小儿膀胱结石进行治疗。年龄1～7岁,结石直径9～27mm。插管全麻仰卧位,经尿道置入8F导尿管,注入生理盐水使膀胱充分充盈。于耻骨联合上1～2cm处用18G穿刺针穿刺膀胱,置入金属导丝。8F筋膜扩张器沿导丝依次扩张皮肤至膀胱至16F,留置16FPeel-away鞘。内窥镜经工作鞘入膀胱,用钬激光或气压弹道击碎结石,碎石沿皮肤膀胱通道冲出。术毕留置12F或14F膀胱造瘘管,未留置导尿管,膀胱造瘘管术后1周拔除。结果本组16例手术均成功,结石取净率100%。患儿无明显出血、肠管损伤等并发症发生,术后随访3～13个月,无排尿困难、无尿道狭窄发生、无结石复发。结论微通道经皮膀胱取石术治疗小儿膀胱结石具有创伤小、痛苦少、操作简便、结石取净率高等优点,可有效避免传统开放手术的较大创伤及经尿道手术导致的术后尿道狭窄的风险。
Objective To investigate the feasibility and clinical efficacy of microchannel percutaneous bladder lithotripsy in the treatment of children with bladder stones. Methods From May 2002 to January 2009, 16 cases of children with bladder stones were treated with microchannel percutaneous bladder lithotomy. Aged 1 to 7 years old, stone diameter 9 ~ 27mm. Intubation supine general anesthesia, transurethral catheterization into the 8F, saline injected into the bladder fully filled. On the pubic symphysis 1 ~ 2cm Department with 18G puncture needle puncture the bladder, into the metal guide wire. 8F fascia dilator along the guide wire followed by expansion of the skin to the bladder to 16F, leaving 16FPeel-away sheath. Endoscopic sclerosis through the work of the bladder, with holmium laser or pressure ballistic crushing stones, gravel along the bladder channel flush out. Laparoscopic placement of 12F or 14F bladder fistula, indwelling catheter, bladder fistula removed one week after surgery. Results The operation of 16 cases in this group were successful. The stone removal rate was 100%. Children without obvious bleeding, bowel injury and other complications occurred, followed up for 3 to 13 months, no dysuria, no urethral stricture, no recurrence of stones. Conclusion Micro-channel percutaneous bladder lithotripsy is very effective in the treatment of children with bladder stones with less trauma, less pain, simple operation and high rate of stone removal, which can effectively avoid the large trauma of traditional open surgery and the postoperative urethral stricture caused by transurethral surgery risk.