目的 比较超声引导下经皮膀胱微通道应用第5代EMS气压弹道联合超声吸附碎石清石技术,与经尿道输尿管下至压弹道碎石术治疗小儿膀胱结石的差别。方法 对比分析了2012-03至2015-12,笔者在超声引导下经皮膀胱微通道应用EMS第5代气压弹道联合超声吸附碎石清石技术,治疗小儿膀胱结石27例(治疗组)与经尿道输尿管镜下气压弹道碎石术治疗小儿膀胱结石25例(对照组)的临床资料。结果 治疗组碎石及取石时间为(15±3)min,平均手术时间为(20±10)min,术后出院时间为(6±1)d,无尿道损伤和结石残留。对照组碎石及取石时间为(40±6)min,平均手术时间为(45±15)min,术后出院时间为(9±2)d。尿道损伤为4例,结石残留为6例,再次手术3例。两组间比较差异均有统计学意义(P<0.05)。结论 超声引导下经皮膀胱微通道应用EMS第5代气压弹道联合超声吸附碎石清石技术,适用于小儿膀胱结石患者,具有微创、安全、净石率高、操作简单、手术时间短、无结石残留、术后恢复快等优点,特别是避免了经尿道反复取石损伤尿道和术后尿道狭窄并发症的风险,值得推广应用。

Objective To evaluate the efficacy of the fifth-generation EMS pneumatic lithotripsy combined with ultrasound adsorption gravel and clearance technology in the treatment of pediatric bladder stones.Methods The clinical data on 27 patients (treatment group) with bladder stones treated with the fifth-generation EMS pneumatic lithotripsy combined with ultrasound adsorption gravel and clearance technology were compared with those on another 25 cases (control) treated with pneumatic lithotripsy under a transurethral ureteroscope.Results In the treatment group, the gravel stone extraction time was (15±3) min, average operative time (20±10) min, and postoperative hospital stay (6±1) days. There was no urethral injury or residual stones. In control group, the stone extraction time was (40±6) min, mean operative time (45±15) min, and postoperative hospital stay (9±2) days. Four of the patients suffered from urethral injury, six from residual stones, and three received a second surgery .There was significant difference between the two groups (P<0.05).Conclusions The ultrasound guided fifth- generation minimally invasive percutaneous EMS pneumatic lithotripsy combined with ultrasound adsorption gravel and clearance technology is suitable for treatment of pediatric bladder stones. This approach has the advantages of minimal invasion, high efficiency, safety, reliability, simple operation, short operation, no stone residuals , quick recovery and no urethral injuries. It is superior to transurethral surgery and should be used more widely.