【摘要】 目的通过比较B超引导经皮膀胱造瘘肾镜EMS碎石与传统开放手术取石治疗特殊类型膀胱结石的效果,探讨简便、有效的微创治疗方法。方法回顾性分析我院2008年2月～2011年9月收治56例特殊类型膀胱结石患者的临床资料,其中结石伴重度前列腺增生20例,结石伴严重尿道狭窄10例,结石伴髋关节功能障碍不能置截石位12例,膀胱憩室结石8例,小儿膀胱结石6例。25例行膀胱切开取石(A组);行B超引导经皮膀胱造瘘肾镜EMS碎石31例(B组),分析比较两种方法在特殊类型膀胱结石治疗中的疗效差异。结果两组56例均一次取石碎石成功,术中无尿道损伤、膀胱破裂、穿孔。术后所有患者复查X片均无结石残留。A、B两组的操作时间分别为(25.2±2.8)min、(31.6±10.5)min,A组小于B组(P<0.05),随结石长径增大,微创手术组操作时间明显延长。A、B两组的住院天数分别为(13.2±3.5)d、(8.1±1.2)d,A组明显大于B组(P<0.01);A、B两组的术后留置导尿管时间分别为(7.0±2.5)d、(5.0±0.9)d,A组显著大于B组(P<0.01);A组伤口感染2例,B组无伤口感染。结论 B超引导经皮膀胱造瘘肾镜EMS碎石治疗特殊类型膀胱结石具有微创、安全、高效、患者恢复快等优点,值得临床推广。更多还原

【Abstract】 Objective To compare the effect between conventional open surgery and nephroscopic pneumatic and ultrasound lithotripsy through suprapubic cystostomy and further explore the effective,rapid and mini-trauma treatment for special types of bladder stones.Methods A total of 56 patients with the special types of bladder stones admitted from February 2008 to September 2011 were retrospectively analyzed.25 cases were treated with open surgery(as group A);31 cases were treated with combination treatment with nephroscopic pneumatic and ultrasound lithotripsy through suprapubic cystostomy(as group B).Results The stones were cleared on one session in all cases without intraoperative injury of urethra,rupture or perforation of bladder.No residual stone was found by X-ray exam.The operating time of group A was 25.2±2.8 minutes,and was obviously shorter than 31.6±10.5 minutes of group B(P<0.05).Along with diameter of calculi increased,the operating time of minimally invasive surgical treatment prolonged obviously.The hospitalization time of group A was 13.2±3.5 days,and was remarkablely longer than 8.1±1.2 days of group B(P<0.01).The duration of indwelling catheter after operation of group A was 7.0±2.5 days,and was significantly longer than 5.0±0.9 days of group B(P<0.01).Wound infection occurred in 2 cases in group A.Conclusion The treatment of nephroscopic pneumatic and ultrasound lithotripsy through suprapubic cystostomy is a mini-invasive,safe and effective therapy for special types of bladder stones,and deserve the clinical expansion.更多还原