无管化微通道经皮肾镜取石术治疗152例嵌顿性输尿管上段结石效果分析

目的 探讨无管化的微通道经皮肾镜取石术(mPCNL)治疗嵌顿性输尿管上段结石的安全性、可行性及手术指征.方法 回顾性分析2011年7月～ 2014年2月之间符合条件的152例输尿管上段结石患者,行一期无管化微通道经皮肾镜下钬激光碎石取石术.在B超引导下经皮肾穿刺并行通道扩张,建立F14～ F18的通道,碎石取石术后常规留置Double-J管及导尿管,记录每例所需要的手术时间、术中出血及输血情况,观察肾盂有无撕裂、有无临近器官损伤,计算结石清除率,记录术后导尿管留置时间及住院时间.结果 152例患者均成功实施一期碎石取石术,术后未留置肾造瘘管,F14通道21例,F16通道75例,F18号通道56例,平均手术时间(54±11) min,手中无活动性出血,无输血,无肾盂撕裂,无邻近脏器损伤.结石清除率97.3％(148/152),4例结石残留[均于术后3～5d复查KUB及B超提示残余结石直径分别为(4.0、3.6、3.5、3.2mm)].无明显尿外渗、大出血等严重并发症.术后平均留置导尿管3.8 ±0.7d.术后平均住院5.0±0.8d.结论 针对性选择符合条件的嵌顿性输尿管结石患者,无管化的微通道经皮肾镜取石术效果满意,安全,术后恢复快,痛苦小,平均住院时间少.     

微创经皮膀胱取石术治疗膀胱结石86例报告

目的 探讨微创经皮膀胱取石术治疗膀胱结石的可行性及相关疗效.方法 我院自2005年6月至2011年4月采用微创经皮膀胱取石术治疗膀胱结石86例.其中成人患者79例,小儿患者7例；男性患者83例,女性患者3例；年龄最大者88岁,最小者2岁.麻醉显效后患者取平卧位,耻骨上2 cm处穿刺入膀胱,建立经皮膀胱通道,留置工作鞘.经鞘置入输尿管镜,行气压弹道碎石,碎石片从鞘中钳取出或冲洗出.术毕缝合穿刺口皮肤,留置导尿.结果 86例手术均获成功,无残余结石,无膀胱穿孔及明显出血,术后排尿通畅,原有尿道狭窄患者无加重,也无新的尿道狭窄发生.结论 微创经皮膀胱取石术治疗膀胱结石具有创伤小、恢复快、清石率高、并发症少、安全及操作简单等优点,可有选择性的在临床开展.     

经皮膀胱造瘘气压弹道碎石治疗膀胱结石

目的探讨经皮膀胱造瘘输尿管镜或F12.5李逊微创肾镜下气压弹道碎石治疗膀胱结石的疗效。方法2003年2月~2006年8月采用经皮膀胱造瘘Peel-away鞘作为手术通道输尿管镜或F12.5李逊微创肾镜下碎石治疗膀胱结石32例。结果碎石时间10~45min,平均25min,均成功取净结石;术中无膀胱出血、穿孔、破裂,无尿道损伤;术后无膀胱、尿道感染。22例术后随访6~20个月,平均15个月,未见结石复发。结论经皮膀胱造瘘输尿管镜或F12.5李逊微创肾镜下气压弹道碎石治疗膀胱结石操作简单、安全、有效。     

经尿道肾镜联合电切镜鞘气压弹道超声碎石清石术在膀胱结石的临床应用

目的 探讨经尿道肾镜联合电切镜鞘气压弹道超声碎石清石术治疗膀胱结石的临床疗效和安全性.方法 回顾性分析采用经尿道肾镜联合电切镜气压弹道超声碎石清石术治疗的34例膀胱结石患者的临床资料,所有患者均经尿道置入F20肾镜,结石大于4 cm可行膀胱造瘘,采用瑞士第四代EMS气压弹道碎石清石系统进行碎石,应用电切镜鞘Ellick冲洗器冲出碎石和肾镜下超声探杆清石,术后留置导尿2～3d.结果 34例患者均手术成功,一次性将膀胱结石去除,无一例中转传统开放性手术,碎石时间8 ～ 45 min,术中术后无膀胱穿孔、大出血、尿道狭窄、急性附睾炎、膀胱痉挛等并发症.结论 经尿道肾镜联合电切镜气压弹道超声碎石清石术治疗膀胱结石是目前疗效确切、适应证广且效率较高的一种有效方法,值得临床上推广应用.     

膀胱镜联合腹腔镜治疗膀胱结石25例报告

目的 探讨膀胱镜联合腹腔镜治疗膀胱结石的可行性.方法 2003年6月～2005年3月我院经尿道插入膀胱镜并连接腹腔镜成像系统,在膀胱镜引导下经耻骨上置入腹腔镜10mm trocar,除胆钳夹碎结石并取出.结果 25例均一次性取净结石.手术时间20～45min,平均30min;术中出血量10～40ml,平均15ml.术后1～3d拨除导尿管,平均1.7d;术后2～7d拨除造瘘管,平均3.1d.无手术并发症发生.术后住院3～8d,平均4.5d.20例随访3～19个月,平均6.2月,无结石复发.结论 膀胱镜联合膀胱镜治疗膀胱结石安全、可行.     

尿道电切镜外鞘联合输尿管镜治疗膀胱结石(附68例报告)

目的 探讨尿道电切镜外鞘联合输尿管镜钬激光治疗膀胱结石的优点与疗效.方法 68例膀胱结石患者,先置入Wolf F24尿道电切镜观察膀胱内部情况,退出内鞘及镜体,留置外鞘,F8输尿管镜由外鞘进入膀胱,钬激光碎石.结果 68例均一次手术成功,术后无结石残留,碎石率100％,手术时间20 ～ 60 min,平均(36.7±...     

经尿道前列腺电切联合小切口膀胱取石术治疗BPH并膀胱结石

目的：探讨BPH合并膀胱结石进行同期治疗更为有效的方法。方法：采用TURP联合经皮小切口卵圆钳膀胱取石术治疗BPH合并膀胱结石患者25例。即在电切镜监视引导下,将卵圆钳经耻骨上小切口插入膀胱腔内取石,再行TURP。结果：25例均一次手术成功,取石率100％,手术时间35～90min,平均65min,其中取石时间3～15min,平均7min;术后留置膀胱造瘘管1～3天,留置尿管3～5天;术后住院时间5～8天,平均6．2天。术后随访3～26个月,无结石复发,Qmax〉15ml／s。结论：TURP联合小切口卵圆钳膀胱取石术治疗BPH合并膀胱结石,具有取石时间短、创伤小、操作简单及安全有效等优点,尤其适合膀胱较大结石或多发结石患者。     

斜跨位超微通道经皮肾镜的疗效分析

目的探讨斜跨位（即斜仰卧-截石位）超微通道经皮肾镜术的有效性及安全性。 方法2016年4月至2017年12月共对我院96例患者施行斜跨位超微通道经皮肾镜碎石取石术。男60例,女36例,年龄25～66岁。结石长径（22±7,15～41）mm。术中将患者置于患侧斜向上45°斜跨位,逆行留置9.5/11.5 F输尿管通道鞘或7 F输尿管导管。在超声引导下进行定位穿刺,穿刺成功后逐步扩张并置入11/13 F超微通道经皮肾镜外鞘。采用200 μm钬激光碎石。取石满意后,根据结石碎片清除情况、通道是否有出血决定是否留置双J管和（或）肾造瘘管。 结果96例患者均顺利完成手术。平均手术时间（76±33）min。术后血红蛋白下降值（16±11）g/L。术后4例出现发热38.5～38.9℃。无其他术中术后并发症。术后平均住院时间（3.9±1.3）d。术后1个月结石清除率91.7%（88/96）。 结论斜跨位下超微通道经皮肾镜术并发症少、术后恢复时间短,且结石清除率较高,值得进一步推广应用。     

经皮肾微造瘘输尿管镜钬激光碎石术治疗上尿路结石

目的探讨经皮。肾微造瘘输尿管镜钬激光碎石术治疗上尿路结石的临床效果。方法本组152例159侧，年龄16～77岁，平均39．8岁。先取截石位，在膀胱镜下向患侧输尿管置入6F输尿管导管至肾盂或输尿管上段结石处，制成人工肾积水后改俯卧位，经皮肾穿刺扩张至16F后置入输尿管镜，看清结石后直视下行钬激光碎石。结果152例患者159侧均一期建立经皮肾通道成功，双侧结石患者分次手术，无一例改行开放手术。术后复查，一期手术结石取净率为84．4％（92／109），二期手术后总结石取净率为88．1％（140/159）。术中无气胸、腹腔脏器损伤、大出血发生。结论经皮。肾微造瘘输尿管镜钬激光碎石术治疗肾、输尿管上段结石具有安全实用、损伤小、并发症少、取石效率高、手术及住院时间短、可重复操作穿刺取石等优点，特别对于开放取石术后残留、复发结石和并发梗阻、肾功能不全者明显优于其他方法，值得推广应用。     

小切口联合经尿道前列腺电切术治疗前列腺增生合并膀胱结石

目的探讨前列腺增生症合并膀胱结石患者同期行膀胱取石和前列腺切除的临床效果。方法回顾性分析2000年9月～2004年6月我院32例采用小切口联合经尿道前列腺电切术(transurethralresectionoftheprostate,TURP)治疗前列腺增生合并膀胱结石的临床资料,腹壁小切口取出膀胱结石,利用此切口留置膀胱造瘘,再行TURP。结果32例均一次手术成功,取石率100%。手术时间45～120min,平均60min。术中出血量50～200ml,平均100ml。术后留置膀胱造瘘管2～3d,三腔气囊尿管3～7d。术后住院5～8d,平均6d。32例随访4～16个月,8例尿道狭窄,经尿道扩张后排尿正常,术后最大尿流率>15ml/s。结论对前列腺增生症合并膀胱大结石或多发结石患者,可首选小切口开放取石联合TURP。     

Percutaneous suprapubic cystolithotripsy approach: for whom? Why?

BACKGROUND AND PURPOSE: To evaluate the success and complications of percutaneous suprapubic cystolithotripsy (PCCL) in pediatric and adult patients with neurogenic bladder. PATIENTS AND METHODS: Between 2000 and 2004, 72 patients, all male (30 children aged 2 to 7 years [mean 4.7 years] and 42 spastic paraplegic adults aged 34 to 62 years [mean 53 years]), with sterile urine underwent PCCL under general anesthesia in one sitting. An 18-gauge needle, Amplatz dilatation set, 30F Amplatz sheath, rigid nephroscope, lithotripter (pneumatic, mechanic), and stone forceps were used. Fluoroscopy was not. A suprapubic catheter was placed in the first two patients only. RESULTS: The dimensions of the stones were on average 3.2 cm (range 1-5 cm) for the pediatric patients and 5.5 cm (4-10 cm) for the adult patients. The operating time was 20 minutes (10-35 minutes). In all cases, the stones were taken out. No serious intraoperative or postoperative complications were observed. In all cases, the transurethral catheter was removed on postoperative day 5. No recurrence was observed during the follow-up period (mean 20 months). CONCLUSION: As urethral diameters are narrow in pediatric patients and adult spastic paraplegic patients in whom an endoscopic approach could not be performed, PCCL is a safe alternative with low morbidity and complication rate. The technique is also more advantageous than open surgery with regard to cosmetic outcome and length of the hospital stay.     

Percutaneous cystolithotomy for pediatric endemic bladder stone: experience with 155 cases from 2 developing countries

Purpose

The aim of this study was to evaluate retrospectively our experience with percutaneous cystolithotomy (PCCL) in children having endemic urinary bladder stones.

Methods

Between January 1993 and June 2003, 155 children younger than 14 years underwent PCCL. The patients' age ranged from 8 months to 14 years (average, 4.5 years). One hundred fifteen patients (74.2%) were 5 years or younger, 31 patients (20%) were between 6 and 10 years, and 9 patients (5.8%) were between 11 and 14 years. There were 153 boys and 2 girls. The stone size ranged from 0.7 to 4 (average, 2.3) cm. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. The instrument was the adult 26F nephroscope, the same that is used for percutaneous nephrolithotomy. Ultrasound disintegration was needed for stones larger than 1 cm. Suprapubic catheter was left for 24 hours. Urethral catheter was kept for 48 hours.

Results

All patients became stone-free. The average operating time was 20 (5-60) minutes. The average hospital stay was 2.7 (2-5) days. No any severe intra- or postoperative complication was observed. The nucleus and/or the main component of the stones were ammonium acid urate in 144 patients (93%).

Conclusions

Based on our experience, we can conclude that PCCL is a safe and effective method for treatment of endemic bladder stones in children. It reduces morbidity and hospital stay, and thus the cost of treatment. Our series proves the nutritional etiology of the endemic pediatric bladder stones.     

Percutaneous versus transurethral cystolithotripsy and TURP for large prostates and large vesical calculi: Refinement of technique and updated data

Background and purpose: We compare two modalities of treatment; transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL), for large vesical calculi in patients who underwent simultaneous transurethral resection of prostate (TURP), and present refinements of the technique of PCCL. Patients and methods: Between July 1999 and June 2003, 54 patients were subjected to either TUCL (n = 19) or PCCL (n = 35) along with simultaneous TURP. Inclusion criteria were prostate volume > 50 ml, aggregate stone size > 3 cm with each individual stone > 1 cm, In the TUCL group, calculi were treated with 26F nephroscope, pneumatic lithotripsy and fragment extraction. This was followed by TURP with 26F continuous-flow resectoscope. In the PCCL group, calculi were removed through a suprapubic 30F Amplatz sheath followed by standard TURP with the suprapubic sheath in situ to provide continuous drainage. A 20F two-way Foley catheter was inserted suprapubically and urethrally in cases of PCCL and a 22–24F three-way catheter urethrally after TUCL. Results: The two groups were comparable in age. The mean prostate size as well as aggregate stone size was significantly larger in PCCL group. The operating time for stone removal was significantly less in the PCCL group while time required for TURP was statistically similar in two groups. In the TUCL arm three patients had residual stones requiring repeat TUCL, and one developed a urethral stricture.Conclusions: Combined TURP and PCCL is safe, more effective and a much faster alternative to combined TURP and TUCL in patients with large bladder calculi and large prostates.     

Percutaneous suprapubic cystolithotripsy for pediatric bladder stones in a developing country

OBJECTIVE: To evaluate our experience with percutaneous suprapubic cystolithotripsy (PCCL) in Yemeni children with endemic urinary bladder stones. PATIENTS AND METHODS: Between January 1993 and December 1998, 117 children underwent percutaneous suprapubic lithotripsy in Arabia Felix Modern Hospital, Sana'a Republic of Yemen. The patients' ages ranged from 8 months to 14 years (average 3.7 years). Ninety patients (77%) were under 5 years old; 20 patients (16%) were between 6 and 10 years old, and 7 patients (6%) were between 11 and 14 years old. There were 116 boys and 1 girl. The stone size ranged from 0.7 to 4 (average 2.3) cm. Five patients had coexisting urinary bilharziasis and another 5 patients had coexisting renal stone. In 10 patients, the stone was in the urethra. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. The instrument was an adult 26-french nephroscope, the same as that used for percutaneous nephrolithotripsy. Ultrasound disintegration was needed for stones of > 1 cm. A suprapubic catheter was left for 24 h, and a urethral catheter was kept for 48 h. RESULTS: All patients became stone free. The average operating time was 15 (5-50) min. The average hospital stay was 2.7 (2-5) days. No severe intra- or postoperative complication was observed. The nucleus and/or the main component of the stones were ammonium acid urate in 109 patients (93%). CONCLUSION: Based on our experience we can conclude that percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. Our series proves the nutritional etiology of endemic pediatric bladder stones. To our knowledge, this is the largest series reported on percutaneous suprapubic management of endemic bladder stones in children.     

Percutaneous suprapubic cystolithotripsy for vesical calculi in children.

BACKGROUND: The majority of vesical calculi in adults can now be treated per-urethrally with the use of ultrasonic or pneumatic lithotripsy. However, the use of these devices is restricted in pediatric patients by the narrow caliber of the urethra. A percutaneous suprapubic approach to the bladder circumvents the problem of urethral caliber in these situations. PATIENTS AND METHODS: Thirty-eight children presenting with bladder stones underwent percutaneous suprapubic cystolithotripsy (PCCL) between November 1989 and April 1996. The age ranged from 1.5 to 7 years. The stone size ranged from 0.8 to 2.4 cm. Seven of these were recurrent stones, and five of the patients were female. The procedure was done under general anesthesia, and the equipment was the same as for upper tract endourology. The bladder was distended with saline and a suprapubic puncture made. The nephroscope was introduced after tract dilation and the stone removed, intact if small or after fragmentation if >1 cm. The procedure was done without fluoroscopy. A suprapubic catheter was left in for 48 hours. RESULTS: All patients had an uneventful recovery following stone removal. The average hospital stage was 3 days. Here, the access provided by percutaneous suprapubic cystostomy has been combined with the experience gained in upper-tract endourology to perform procedures that would otherwise require open operation because of nonavailability of urethral access. CONCLUSION: Extension of endourologic procedures to the lower tract reduces morbidity and hospital stay and thus the cost of treatment. Percutaneous suprapubic cystolithotripsy, in our experience, is a safe and cost-effective alternative to open surgery in children.     

经电切镜外鞘气压弹道治疗膀胱结石20例报告

目的探讨气压弹道治疗膀胱结石的新方法. 方法经电切镜外鞘置入输尿管镜或肾镜,气压弹道将膀胱结石击碎取出. 结果 20例均顺利一次性将结石取尽.术中、术后无大出血、膀胱穿孔和水中毒等并发症.20例术后随访2～18个月,平均4.6月,B超未见结石复发,无排尿不畅等尿道狭窄症状. 结论电切镜外鞘气压弹道碎石是处理膀胱结石的有效方法.     

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

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2.8 cm(1.0~4.5 cm),平均1.8枚结石/例.采用耻骨上经皮膀胱微造瘘通道,用Wolf 8/9.8 F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2.95 cm(2.8~5.0 cm),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55 min(15~120 min).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180 min(110~200 min).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.     

Minimally invasive percutaneous cystolithotomy: an effective treatment for bladder stones in infants aged <1 year

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To present our experience with minimally invasive percutaneous cystolithotomy (MPCCL) for the treatment of bladder stones in infants aged <1 year.

PATIENTS AND METHODS

From 1 January 2003 to 31 October 2008, 15 boys with a mean (range) age of 8.2 (3.0–11.5) months underwent MPCCL. The mean (range) stone diameter was 1.4 (0.9–2.2) cm. Ten infants had a solitary stone while five had more than one stone. MPCCLs were performed under general anaesthesia. A 16 F peel‐away sheath was introduced as a working tract after dilatation with percutaneous nephrolithotomy dilators (8–16 F) under fluoroscopic control. After dilatation, an 8–9.8 F ureteroscope was introduced into the bladder, and the stones were fragmented with a shock wave lithotriptor. After the MPCCL, a 14 F suprapubic catheter was left in situ and fixed to the skin, and removed 1 or 2 days after MPCCL. The urethral catheter was removed 2 or 3 days after MPCCL. The absence of stone fragments on plain X‐ray/ultrasonography was considered as a ‘stone‐free’ status.

RESULTS

All infants were stone‐free after one MPCCL; no recurrent stones developed. The mean MPCCL procedure time was 25 min and intraoperative blood loss was scant. Perioperative complications were few. The mean hospital stay was 2.8 days.

CONCLUSION

MPCCL is a safe and effective treatment option for bladder stones in infants, reducing postoperative complications and shortening hospital stay.     

经皮胆囊碎石术的疗效及适应证分析(附120例报告)

目的:评价与探讨经皮胆囊碎石术(PCCL)治疗胆囊结石的临床价值及适应证。方法:回顾总结PCCL120例患者的临床资料。结果:手术成功率95.2％,术后并发症12.5％,总治愈率87.5％,术后平均随访23个月,结石复发率13.3％,结石复发主要和术前胆囊功能状况及结石数量有关。结论:PCCL具有简便易行,手术成功率及净石率高、并发症少,近期疗效较好等优点,结石复发是其主要缺点,严重影响其远期疗效。PCCL在当前仍有临床应用价值,正确掌握适应证,选择胆囊功能良好,结石数少,体积小的病例,可降低术后结石复发率。     

前列腺增生术后继发下尿路结石的治疗(附23例报告)

目的 总结良性前列腺增生术后继发下尿路结石的原因及治疗。方法 将输尿管镜经过电切镜鞘置入膀胱，使用气压弹道碎石机粉碎结石，同时行电切及冷刀内切开处理下尿路梗阻。结果 23例患者均一次性粉碎结石并取出，同时处理下尿路梗阻的原因。结论 经电切镜鞘使用气压弹道机粉碎膀胱结石的方法是一种经济、简便、有效的治疗措施。