开放和微创对高危大体积前列腺增生合并膀胱结石的同期治疗比较研究

Comparison of two surgical techniques for giant benign prostatic hyperplasia { BPH } combined with bladder calculi at high risk period

目的比较开放与微创两种方法对高危巨大前列腺增生合并膀胱结石的同期治疗临床效果。方法高危巨大前列腺增生合并膀胱结石患者77例，其中膀胱切开取石同时前列腺剜除术49例，同期气压弹道碎石加前列腺电切术28例。对比分析两组治疗的临床资料及随访结果，比较两组的治疗效果。结果两组患者均一次手术成功。与微创组比较，开放手术组手术时间、住院费用具有明显优势，差异均有统计学意义（t分别=3．81、15．97，P〈0．01）；而术后膀胱冲洗时间、留置尿管时问、住院时间比较，微创组具有优势，差异均有统计学意义（t分别=3．23、7．84、6．15，P〈0．01）。术后随访6个月，未见结石复发，国际前列腺症状评分（IPSS）、最大尿流率（MFR）较术前均有显著改善。微创组发生短暂电切综合征（TURS）5例，术后出血2例，尿道狭窄2例，尿路感染2例；开放组尿道狭窄3例，尿路感染2例。结论两种手术方法均安全有效，微创治疗虽然术后恢复较早，但手术时间较长，残余腺体多，手术并发症并不比开放手术少；开放手术具时间短、切除完全、费用低等优点，仍不失为治疗巨大前列腺增生合并膀胱结石的较好选择。

Objectives To compare the clinical features and results between open and minimal invasive technique in treating giant prostates combined with bladder calculi at high risk period. Methods Seventy - seven patients at high risk period suffered from giant prostates with bladder calculi underwent suprapubic lithotomy and prostatectomy （ n = 49） or combination of transurethral resection of the prostate and ballistic lithotripsy （ n = 28 ）. The two approaches were evaluated and compared with data from intraoperation and postoperation. Results All the surgeries succeeded,For the open and minimal invasive techniques, the operating time was （53 ± 17） rain and （138 ± 32 ） rain, blood loss （218 ± 42） ml and （225 ± 35 ） ml,The bladder washing time （ 5.1 ±1.7 ） d and （ 2.3 ±1.9 ） d, catheterization time （ 10.3± 1.7 ） d and （ 7.2 ±1.3 ） d, The average hospitalization （ 13.5 ± 2.1 ） d and （ 8.6 ± 2. 8 ） d, the cost （ 5203 ± 1285 ） yuan and （ 11218 ± 2301 ） yuan, respectively ; Compared with minimal invasive group, the operating time and hospital cost were significantly superiority in open group（ p 〈 0.01 ）. But compared with open group, the bladder irrigation time, catheterization time, and hospital stay were significantly superiority in minimal invasive group（ p 〈0. 01 ）. After a follow up of six months,the IPSS decreased from （28.6 ±4.7） and （28.3±4.1 ） to （5.5± 1.4）and（5.6 ± 1.2） ,MFR from （5.6 ±0.5）ml/s and （5.7 ±0.6） ml/s to（23.3 ±9.5） mL/s and（22.4 ±8.9）ml/s,respectively. All of them were significantly improved in both groups,but no significantly difference between two groups, minimal invasive technique had 5 TURS,2 bled postoperation,2 urethremphraxis,2 urinary tract infection;The open treats had 3 urethremphraxis,2 urinary tract infection. Conclusions Although minimal invasive technique had quicker recovery, but operating time were longer,complications in intraoperation and postoperation didnt less than Open surgery;So open surgery is still a feasible treatment option for patients suffered from a giant prostate with bladder calculi for which has the benefit of a short operating time,less complications of TunS, and less cost for treatment.