Department of Pediatric Urology, Children's Medical Center, Dallas, TX 75207, USA.
J Pediatr Urol. 2013 Aug;9(4):479-82. doi: 10.1016/j.jpurol.2012.05.018. Epub 2012 Jun 30.
To present our initial experience with "mini" percutaneous cystolithotomy performed as an outpatient procedure in patients with neurogenic bladders.
MATERIALS & METHODS: Over the last 6 years, patients with neurogenic bladders and bladder calculi were managed with outpatient percutaneous cystolithotomy. All but 1 had previously undergone appendicovesicostomy (APV) creation. The procedure was performed by first passing a pediatric cystoscope per APV. Once the calculi were visualized, and following bladder distention, additional bladder access was obtained by passage of either a 16F Peel-Away introducer using the Seldinger technique or a 5 mm laparoscopic trocar under direct vision. An ultrasonic lithotripter was then advanced through the percutaneous access site and stone fragmentation completed. Following procedure completion, a catheter was placed for 24 h for bladder decompression. All procedures were performed on an outpatient basis.
12 patients underwent 18 successful operations. In 1 patient, percutaneous access was unsuccessful. Mean age at surgery was 12.3 years. Mean operative time was 72 min 8 patients had undergone previous ileocystoplasty. The remainder was rendered stone free at the completion of surgery. One patient had persistent bleeding from the intravesical trocar site necessitating fulguration and an overnight stay for observation. The remainder were sent home the same day. There were no cases of urine extravasation.
"Mini" percutaneous cystolithotomy is a safe, effective technique for the outpatient management of bladder calculi.
介绍我们在神经源性膀胱患者中行门诊“迷你”经皮膀胱切开取石术的初步经验。
在过去的 6 年中，我们对患有神经源性膀胱和膀胱结石的患者采用门诊经皮膀胱切开取石术进行治疗。除 1 例患者外，所有患者均曾行阑尾膀胱吻合术（APV）。该手术首先通过 APV 插入小儿膀胱镜。一旦发现结石，并在膀胱扩张后，通过 Seldinger 技术经皮插入 16F Peel-Away 导入器或直接插入 5mm 腹腔镜套管针获得额外的膀胱通道。然后将超声碎石器通过经皮进入点推进，并完成碎石。手术完成后，放置导尿管 24 小时以进行膀胱减压。所有手术均在门诊进行。
12 例患者成功完成了 18 例手术。1 例患者经皮进入失败。手术时的平均年龄为 12.3 岁。平均手术时间为 72 分钟，8 例患者曾行回肠膀胱成形术。其余患者在手术结束时均已排净结石。1 例患者因膀胱内套管针部位持续出血，需要电灼和观察过夜而留院。其余患者当天出院。无尿外渗病例。
“迷你”经皮膀胱切开取石术是一种安全、有效的门诊治疗膀胱结石的技术。
