经皮膀胱微造瘘输尿管镜碎石加经尿道逆行注水治疗特殊类型膀胱结石  

Minimally invasive percutaneous transvesical ureteroscopic lithotripsy conbined retrograde water injection through catheter to treat the special types of bladder stones

作　　者：顾思平[1] 黄云腾[2] 周晓明[1] 卢奕进 游志远[1] 

机构地区：[1]福建省石狮市医院微创外科,362700 [2]上海交通大学附属新华医院泌尿外科,200092

出　　处：《中华腔镜泌尿外科杂志（电子版）》2012年第1期21-24,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：2011年泉州市科研重点立项项目(2011T5);2011年石狮市科技局立项资助项目(2011SN28)

摘　　要：目的探讨经皮膀胱微造瘘输尿管镜碎石加经尿道逆行注水治疗特殊类型膀胱结石的适应症和疗效。方法将48例膀胱结石患者分为两组,A组(观察组),B组(对照组)。A组患者35例,男性32例,女性3例,平均年龄52.5(5～91)岁,结石伴重度前列腺增生19例,结石伴尿道严重狭窄5例,结石伴髋关节功能障碍不能置膀胱截石位3例,小儿膀胱结石8例。结石大小平均2.8cm(1.0～4.5cm),平均1.8枚结石/例。采用耻骨上经皮膀胱微造瘘通道,用Wolf8/9.8F输尿管肾镜下气压弹道(或钬激光)碎石治疗。B组(对照组)患者13例,男11例,女2例,平均年龄61.5(17～78)岁,结石伴重度前列腺增生6例,无儿童患者,无尿道狭窄患者,无髋关节功能障碍患者,结石大小平均2.95cm(2.8～5.0cm),多发结石8例,平均2.1枚结石/例。采用经尿道腔镜碎石治疗。结果 A组患者结石一次性结石清除率100%(35/35),平均手术时间55min(15～120min)。B组患者结石一次性结石清除率69.2%(9/13),需二次手术清除干净4例,残石率30.8%,膀胱穿孔1例,膀胱出血中转开放手术1例,术后出现尿道炎伴急性睾丸炎1例;平均手术时间180min(110～200min)。结论经皮膀胱微造瘘通道输尿管镜碎石加经尿道逆行注水治疗特殊类型膀胱结石具有简便、安全、高效、微创的特点,值得临床推广。Objective To evaluate the indications and the effects of minimally invasive percuta- neous transvesical ureteroscopic lithotripsy conbined retrograde water injection through catheter to treat the special types of bladder stones. Methods Forty-eight patients with bladder stones were divided into two groups, group A （observed group） and group B （control group）. Thirty-five patients with bladder stones were enrolled into group A, including 32 males and 3 females, aging from 5 to 91 years （mean, 52.5）. Of these paitients, 19 of them combined with severe benign prostatic hyperplasia, 5 combined with urethral stenosis, 3 combined with hip joint dysfunction who were unable to be set lithotomy position, and the remaining 8 cases were all pediatric paitients. The average stone size in group A was 2.8 cm （range, 1.0-4.5 cm）. Pneumatic lithotripsy was performed using Wolf F 8/9.8 ureterorenoscope through the channel of uprapubic minimally invasive percutaneous cystostomy. Thirteen patients with bladder stones were enrolled into group B, including 11 males and 2 females, the mean age was 61.5 years （range, 17-78）, 6 of them combined with severe benign prostatic hyperplasia. Pediatric patients and those who suffered from urethral stenosis, hip joint dysfunction were excluded in group B. The average stone size was 2.95 cm （range, 2.8-5.0 cm）. Transurethral pneumatic lithotripsy was performed using Wolf 8/9.8 F ureterorenoscope. Results In group A, lithotripsy was performed successfully in all patients, the stone clearance rate was 100% （35/35） through one time of procedure, the average operation.time was 55 rain （15-120 min） without any obvious complica- tions such as bladder perforation, large blood loss, septicaemia or epididymitis. In group BI lithotripsy was performed successfully in 9 patients at the first time, the stone clearance rate in one time was 69.2% （9/13）. The remaining 4 patients （30.8%） needed second operation to treat the residual stones. The average opera- tion time wa

关 键 词：经皮膀胱微造瘘 特殊类型膀胱结石 输尿管镜 经尿道逆行注水 气压弹道 钬激光 

分 类 号：R699[医药卫生—泌尿科学]