Riley Children's Hospital, 702 Barnhill Drive, Suite 4230, Indianapolis, IN 46202, USA.
J Pediatr Urol. 2013 Jun;9(3):289-92. doi: 10.1016/j.jpurol.2012.05.004. Epub 2012 Jul 13.
We present our results of percutaneous cystolithotomy with laparoscopic trocar (PCLT) access in children.
PCLT was performed in 13 cases. This includes 2 patients who had this performed twice for recurrent stone 12-24 months after initial surgery. Eight patients had a bladder augmentation, 2 had native bladders, and one a continent urinary reservoir. Nine patients had a reconstructed urethra. Cystoscopy was performed in all cases to assess stone burden. Under direct vision, an 18 gauge angiocatheter was placed into bladder and guidewire placed through the angiocatheter. With the bladder distended, a laparoscopic 10 mm trocar was placed under vision next to the guidewire. A 26Fr nephroscope was used via the trocar to extract the stones, utilizing laser or ultrasonic lithotripsy to fragment larger stones. Stone fragments were removed with graspers and/or the vacuum extraction technique.
PCLT was successful in all cases. No complications were noted. Six cases were treated as outpatient, seven discharged home after 12-23 h observation.
PCLT via laparoscopic trocar access is a facile and safe approach for removing stones in the pediatric neuropathic bladder. Advantages include the ability to distend the bladder with continuous flow and the larger working channel permitting use of the nephroscope to treat and extract stones.
我们介绍了经皮膀胱镜碎石术（PCLT）联合腹腔镜套管针入路治疗儿童膀胱结石的结果。
13 例患儿接受了 PCLT 治疗。其中 2 例患儿因结石复发，在初次手术后 12-24 个月接受了 2 次 PCLT 治疗。8 例患儿行膀胱扩大术，2 例患儿行固有膀胱手术，1 例患儿行可控性膀胱尿流改道术。9 例患儿行尿道重建术。所有患儿均行膀胱镜检查评估结石负荷。直视下，将 18 号血管鞘插入膀胱，并将导丝穿过血管鞘。在膀胱充盈的情况下，在导丝旁通过腹腔镜 10mm 套管针插入膀胱。通过套管针插入 26Fr 肾镜，利用激光或超声碎石术将较大的结石碎成小块。使用抓钳和/或真空抽吸技术取出结石碎片。
所有患儿均成功完成 PCLT 治疗，无并发症发生。6 例患儿作为门诊患者接受治疗，7 例患儿在观察 12-23 小时后出院。
腹腔镜套管针入路的 PCLT 是治疗小儿神经源性膀胱结石的一种简便、安全的方法。其优点包括能够通过持续流动来充盈膀胱，并且工作通道较大，允许使用肾镜来治疗和提取结石。
