前列腺增生症合并膀胱结石的手术治疗体会

Surgical treatment of BPH complicatated with bladder stones

目的探讨前列腺增生症(BPH)合并膀胱结石一次性手术治疗的方法和疗效。方法采用经尿道前列腺汽化电切术(TVP)结合体外震波碎石(ESWL)、直视下膀胱镜碎石钳机械碎石(OMC)和耻骨上小切口膀胱切开取石(SCL)一次性手术治疗BPH合并膀胱结石患者48例。结果TVP结合ESWL 11例,2例碎石不完全者经辅以OMC后取尽结石;TVP结合OMC 23例,1例膀胱穿孔行修补术;TVP结合SCL 14例,恢复良好。手术历时50-100分钟,其中碎石时间10-30分钟,切开取石时间为20-40分钟,前列腺汽化电切时间一般在60分钟以内,未发生前列腺电切综合征(TURS),无尿瘘等手术前发症发生。结论TVP结合ESWL、OMC及SCL一次性治疗BPH合并膀胱结石具有创小、效果好等优点,特别适合于高危高龄患者。上述各种技术的良好配合是手术成功的关键。

Objective To investigate the indication and efficacy in the surgical treatment of BPH complicated with bladder stones. Methods 48 cases of BPH complicated with bladder stones treated by ESWL and OMC or SCL and TURP or TVP were retrospectively reviewed. Results 11 patients of bladder stones were treated by ESWL and not cleared up completely in 2 cases. 23 cases were with OMC, intmoperative bladder perforation occurred in 1 cases. 14 cases were with SCL and all of them were operation on successfully by TURP or TVP. The operation time was 50 - 100 minutes. ESWL or OMC was 10 - 30 minutes and SCL was 20 - 40 minutes. TURP or TVP was within 60 minutes. All patients no TURS and fistulas occurred. Conclusion The use of these techniques combined ESWL and OMC or SCL with TURP or TVP is an effective and mini - invasion for the treatment of BPH with bladder stones. This procedure is specially applicable to patients with advance age. Proficiency in techique is a key to a successful operation.