前列腺增生合并输尿管结石的同期腔镜治疗分析

Simultaneous endoscopic treatment of benign prostate hyperplasia and ureteral calculi

目的:探讨腔镜下同期处理前列腺增生和输尿管结石的可行性、疗效及并发症。方法:回顾性分析我院2000年1月至2008年12月收治的前列腺增生并发输尿管结石病例,对腔镜下同期处理前列腺增生和输尿管结石的病例进行疗效评价。结果:患者58例,平均年龄62.3岁。前列腺增生程度:Ⅰ度12例,Ⅱ度35例,Ⅲ度11例,其中输尿管下段结石29例,中段结石10例,上段结石19例。所有病例均同期行输尿管镜下输尿管结石双频激光(U100)碎石取石术和经尿道前列腺电切术,成功行碎石取石48例,有3例输尿管镜无法上行至上段改为单纯留置双J管,置镜失败2例,失败原因为输尿管口显示不清,3例输尿管上段结石置镜过程中结石移位至肾盂,未能碎石。另有2例患者术后证实有结石残留。所有患者经尿道前列腺增生电切术均顺利,无严重并发症。术后4～6d拔除尿管,无尿失禁及尿潴留,1个月拔除双J管。结论:前列腺增生合并输尿管结石,可同期行输尿管镜下碎石和经尿道前列腺电切手术,治疗效果确切,无严重并发症。

Objective： To evaluate the feasibility and curative effect of simultaneous endoscopic treatment of benign prostate hyperplasia and ureteral calculi. Methods ： Patients who underwent simultaneous transurethral resection of the prostate and ureteroscopic lithotripsy for benign prostate hyperplasia and ureteral calculi from January 2000 to December 2008 in our hospital were analyzed retrospectively. Results： There were total 58 female patients who underwent TURP and URSL simultaneously. The degree of BPH was I in 12 patients, II in 35 patients and III in 11 patients. The location of the calculi were in the distal ureter with 29 patients, medal ureter in 10 patients, and proximal ureter in 19 patients. All patients underwent simultaneous TURP and ureteroscopic lithotripsy with Frequency Doubled Double Pulse Nd：YAG Laser. The calculi were broken and removed successfully in 48 patients. Three patients only undrwent double J stents placement because the ureteroscope could not reach the proximal ureter where the calculi located. Retrograde stone displacement occurred in another 3 patients. The ureteroscope failed to be placed into the ureters of two patients because the ureterostomas could not be seeked. Another 2 patients were confirmed to be with calculous residual. TURP was performed successfully in all patients without serious complications. Conclusion： Patients with BPH and ureteral calculi can be treated with TURP and URSL simultaneously with good effect and little serious complications.