双极等离子体电切联合钬激光碎石同期治疗前列腺增生合并膀胱结石

Plasmakinetic Bipolar Vaporized Resectoscopy Combined with Holmium Laser for Benign Prostatic Hyperplasia with Bladder Stones

目的探讨良性前列腺增生（benign prostatic hyperplasia,BPH）合并膀胱结石的安全有效的治疗方法。方法采用英国Gyrus等离子双极电切系统和美国科以人Lumenis100W钬激光系统,钬激光550μm光纤由等离子电切镜操作通道置入碎石,治疗参数为1.5~3.0J/15~25Hz,总功率30~60W,平均48W。冲出结石碎块,更换等离子电切环,从中叶到两侧叶切除前列腺腺体直至前列腺包膜,前列腺尖部切至精阜前缘,留置F20三腔尿管,术后生理盐水冲洗1~2d。结果 128例手术均获成功,手术时间42~135min,（64±22）min,其中前列腺切除时间（42±20）min,碎石时间（16±12）min。术后4~5d拔除尿管排尿通畅,无电切综合征、闭孔神经反射、膀胱穿孔等并发症,无结石残留。128例随访6~12个月,平均8个月,术后6个月国际前列腺症状评分由（26.5±4.2）分降至（6.8±1.2）分（t=16.782,P=0.000）;生活质量评分由（4.6±0.6）分降至（1.8±0.6）分（t=11.561,P=0.000）;最大尿流率由（5.3±3.2）ml/s升至（20.2±4.2）ml/s（t=12.684,P=0.000）;残余尿量由（118±52）ml降至（16±9）ml（t=18.544,P=0.000）。结论双极等离子体电切联合钬激光碎石是治疗BPH并膀胱结石微创、安全而有效的方法 。

Objective To explore the effectiveness of the combination of plasmakinetic bipolar vaporized resectoscope with holmium laser in the treatment of benign prostatic hyperplasia（BPH）complicated with bladder stones.Methods Gyrus plasmakinetic bipolar vaporized resectoscope and Lumenis 100 W holmium laser were concomitantly performed on 128 patients with BPH and bladder stones.Holmiun laser lithotripsy were performed with 550 μm optic fiber under a ureteroscope via outer sheath of resectoscope（1.5-3.0 J/15-25 Hz,30-60 W with a mean of 48 W）.After cystic stones were broken into small fragments,TUPKRP was performed.After the operation,a F_20 catheter was indwelled and PBS was used for washing.Results The operation was completed successfully in all of the 128 cases.The mean operation time was（64±22）min（range：42-135 min）,during which（42±20）min were for resection of the prostate,and（16±12）min for lithotripsy.Urethral catheter was withdrawn in 4 to 5 days after the operation.No patients had TURS,obturator nerve reflex,bladder perforation,or residual calculi after decatheterization.The patients were followed up for 6 to 12 months with a mean of 8 months,during which the mean Qmax of the patients significantly increased compared to pre-operation [from（5.3±3.2）ml/s to（20.2±4.2）ml/s,t=12.684,P=0.000;and the IPSS and life quality score markedly decreased [from（26.5±4.2）and（4.6±0.6）to（6.8±1.2）and（1.8±0.6）;t=16.782 and 11.561;both P=0.000].Conclusion Combination of plasmakinetic bipolar vaporized resectoscope with holmium laser is a minimally invasive and effective treatment for BPH complicated with bladder stones.