摘要
报告1例49岁因车祸致C5椎体骨折损伤脊髓后高位截瘫继发神经源性膀胱并发膀胱结石的男性患者,记录患者术中、术后及预后等情况,并结合相关文献进行讨论。术前根据患者病史及影像学资料诊断高位截瘫、神经源行膀胱合并膀胱结石。一期手术尝试在无麻醉状态下经耻骨上膀胱造瘘途径联合输尿管肾镜碎石取石术。术中出现自主神经反射亢进及腹腔积液等并发症,经紧急处理后终止手术并改期;二期手术采用蛛网膜下腔阻滞麻醉,顺利完成碎石取石。术中及术后均未发生明显并发症。复查B超提示无结石残留,恢复情况好,顺利出院。对于高位截瘫合并神经源性膀胱继发膀胱结石的患者,术前评估需多学科协作,制定个体化的麻醉方案、手术策略及康复指导。术中如出现不良事件(如自主神经反射亢进),应及时识别并采取有效处置措施,确保患者安全,避免严重并发症的发生。
The article reported the case of a 49-year-old male who developed high-level paraplegia following a traumatic spinal cord injury due to a C5 vertebral fracture sustained in a car accident.The patient subsequently developed a neurogenic bladder complicated by bladder stones.Intraoperative,postoperative,and prognostic data were recorded and discussed in conjunction with relevant literature.Preoperative diagnosis,based on medical history and imaging studies,included high-level paraplegia and neurogenic bladder with concurrent bladder calculi.In the first-stage surgery,an attempt was made to perform suprapubic cystostomy combined with ureteroscopic lithotripsy and stone removal without anesthesia.However,complications such as autonomic hyperreflexia and abdominal fluid accumulation occurred during the procedure.The operation was terminated and rescheduled after emergency management.In the second-stage surgery,spinal anesthesia(subarachnoid block)was administered,and the lithotripsy and stone removal were successfully completed.No significant intraoperative or postoperative complications occurred.Follow-up ultrasound showed no residual stones,and the patient recovered well and was discharged smoothly.For patients with high-level spinal cord injury and neurogenic bladder complicated by bladder stones,preoperative evaluation requires multidisciplinary collaboration to formulate an individualized anesthetic plan,surgical strategy,and rehabilitation guidance.If adverse events such as autonomic hyperreflexia occur intraoperatively,they should be promptly recognized and effectively managed to ensure patient safety and prevent serious complications.
作者
杨博
王磊
Yang bo;Wanglei(Department of Urology,Hospital of the chinese People's Liberation Army 96603,Huai hua,Hu nan 418000,China)
出处
《泌尿外科杂志(电子版)》
2025年第3期70-73,共4页
Journal of Urology for Clinicians(Electronic Version)
