同期腔内手术治疗前列腺增生及其合并症

Simultaneous Endoscopic Operations for Benign Prostate Hyperplasia Combined with Complications

目的 探讨同期腔内手术治疗良性前列腺增生（BPH）及其合并症的可行性。方法BPH患者95例,其中合并膀胱结石52例,膀胱肿瘤27例,尿道狭窄9例,输尿管结石7例,均行经尿道前列腺电汽化术（TUVP）,同期行膀胱结石机械碎石术、经尿道膀胱肿瘤电切术（TURBt）、尿道内切开或输尿管镜下气压弹道碎石术。结果 所有病例均顺利完成手术,术中膀胱粘膜损伤4例,穿孔1例。术后排尿困难及尿频症状明显改善,IPSS评分（9.7±3.6）分,最大尿流速率（18.3±2.9）ml/s。89例术后随访3-48个月,BPH及膀胱结石均无复发。6例膀胱肿瘤复发,但复发部位不位于前列腺窝,再次行TURBt;合并尿道狭窄患者1例术后出现再狭窄予再次内切开治愈。输尿管结石患者术后结石全部排出,肾积水减轻或消失。结论 BPH合并膀胱结石、膀胱肿瘤、尿道狭窄或输尿管结石可同期腔内手术治疗。

Objective To evaluate the feasibility of simultaneous endoscopic operations for benign prostate hyperplasia （BPH） and complications. Methods 95 patients of BPH and complications underwent simultaneous endoscopic transurethral vaporization of the prostate （TUVP） in all cases, endoscopic alechanical lithotripsy of bladder in 52 cases of combined bladder calculi, transurethral resection of bladder tumor（TURBt） in 27 cases of combined bladder tumor, internal urethrotomy in 9 cases of combined urethrostenosis, and ureteroscopic pneumatic lithotripsy in 7 cases of combined ureteral calculi. Results All operations succeeded with 4 cases of bladder mucosa injury and l case of perforation. Symptoms as dysuria and sychnuria were improved with （9.7 ±3.6） of IPSS Score and （ 18.3 ± 2.9 ） nd/s of maximum urinary flow rate. 89 patients were followed up for 3 - 48 months. No BPH or bladder calculi relapsed. 6 cases underwent TURBt again with bladder neoplasms recurrence, but no tumor implantation was found in prostatic fossa, l case of urethral stricture relapsed and was cured by reoperation of internal urethrotomy. All stones were removed and hydronephrosis was improved in urethral calculi patients. Conclusion Simultaneous endoscopic operation is feasible for BPH combined with other urinary diseases such as bladder calculi, bladder tumor, urethrostenosis, or ureteral calculi.