经尿道前列腺等离子剜除术联合耻骨上小切口切开膀胱治疗大体积良性前列腺增生合并膀胱结石的疗效

Clinical effect of transurethral plasmakinetic enucleation of the prostate combined with small suprapubic incision in the treatment of large benign prostatic hyperplasia complicated with bladder lithiasis

目的:探讨经尿道前列腺等离子剜除术(PKEP)联合耻骨上小切口切开膀胱取石治疗大体积良性前列腺增生(BPH)合并膀胱结石的疗效。方法:纳入2017年1月至2019年6月中南大学湘雅医学院附属海口医院泌尿外科因下尿路症状(LUTS)而就诊的BPH合并膀胱结石患者76例,根据治疗方法分为研究组36例和对照组40例。研究组采用PKEP联合耻骨上小切口切开膀胱取石治疗,对照组采用PKEP联合经尿道钬激光碎石术(THLL)治疗。比较两组患者术前、围手术期及术后指标。结果:两组患者年龄、IPSS评分、前列腺体积、膀胱结石负荷、Qmax、PSA等基线资料比较差异无统计学意义(P>0.05)。研究组较对照组手术时间短[(73.23±9.96)vs(103.73±18.12)min]、术中出血量少[(39.63±11.73)vs(62.25±12.03)ml]、切除腺体重量大[(55.15±14.39)vs(45.00±17.96)g]、术后膀胱冲洗时间短[(1.38±0.54)vs(1.88±0.72)d]、术后拔管时间长[(5.13±1.04)vs(3.08±0.97)d],差异均具有统计学意义(P<0.05)。术后随访3~18个月(平均7.5月),两组患者术后IPSS评分、术后3个月控尿率、术后尿道狭窄发生率差异无统计学意义。结论:PKEP联合小切口切开膀胱取石安全有效,在没有组织粉碎器条件下,对大体积BPH合并膀胱结石患者,尤其是结石负荷大、无法耐受长时间手术患者,可明显节约手术时间,减少术中出血量,同时不增加术后并发症风险。

Objective:To investigate the efficacy of transurethral plasmakinetic enucleation of prostate(PKEP)combined with suprapubic small incision for bladder stone extraction in the treatment of large volume benign prostatic hyperplasia(BPH)complicated with bladder stones.Methods:From January 2017 to June 2019,76 patients with BPH complicated with bladder stones due to lower urinary tract symptoms(LUTS)were selected in the Department of Urology,Haikou Hospital,Xiangya Medical College,South Central University.According to the treatment methods,the patients were divided into study group(n=36)and control group(n=40).The study group was treated with PKEP combined with suprapubic small incision for bladder lithotomy,and the control group was treated with PKEP combined with transurethral holmium laser lithotripsy(THLL).The preoperative,perioperative and postoperative indexes were compared between the two groups.Results:There was no significant difference in age,IPSS score,prostate volume,bladder stone load,Qmax,PSA and other baseline data between the two groups(P>0.05).The study group had shorter operation time[(73.23±9.96)vs.(103.73±18.12)min],less intraoperative blood loss[(39.63±11.73)vs.(62.25±12.03)mL],greater weight of excised glands[(55.15±14.39)vs.(45.00±17.96)g],shorter postoperative bladder irrigation time[(1.38±0.54)vs.(1.88±0.72)d],and longer postoperative extubation time[(5.13±1.04)vs.(3.08±0.97)d]than the control group.The differences were statistically significant(P<0.05).After 3-18 months of follow-up(mean 7.5 months),there was no significant difference between the two groups in IPSS score,continence rate at 3rd month and incidence of postoperative urethral stricture.Conclusion:PKEP combined with small-incision bladder lithotomy is safe and effective.In the absence of tissue crusher,it can significantly save operation time,reduce intraoperative blood loss and not increase the risk of postoperative complications for patients with large volume BPH complicated with bladder stones,especially those with large stone load and unable to tolerate long-term operation.