经尿道前列腺电切联合钬激光一期治疗前列腺增生伴膀胱结石的临床分析

Therapeutic efficacy of transurethral resection of the prostate combined with holmium laser in the treatment of benign prostatic hyperplasia with bladder stones

目的探讨经尿道前列腺电切(transurethral resection of the prostate,TURP)联合钬激光一期治疗良性前列腺增生(benign prostatic hyperplasia,BPH)伴膀胱结石的疗效。方法 108例患者先行钬激光治疗膀胱结石,然后行TURP治疗BPH。结果 108例患者碎石时间10～65 min,平均31 min;TURP时间35～115 min,平均54 min。1例患者术后出现出血而行二次镜下止血,其余患者术后未出现明显出血;108例患者术中术后均未出现电切综合征、膀胱穿孔、结石残留、尿道狭窄等并发症。术后5～7 d拔除导尿管后排尿通畅。7例出现暂时性尿失禁,经康复治疗后痊愈。术后3个月复查,无膀胱结石复发,国际前列腺症状评分(international prostate symptom score,IPSS)由(21.6±4.7)分下降至(6.9±1.1)分(P<0.01),生活质量评分(quality of life,QOL)由(5.4±0.9)分下降至(2.2±0.6)分(P<0.01),最大尿流率(maximum flow rate,Qmax)由(6.9±1.4)mL/s升至(16.8±2.3)mL/s(P<0.01)。结论 TURP联合钬激光一期治疗BPH伴膀胱结石,安全有效、创伤小、恢复快、并发症少、住院时间短、费用降低,逐渐为众多的老年男性患者所接受。

Objective To investigate the therapeutic efficacy of transurethral resection of the prostate（TURP） combined with holmium laser in the treatment of benign prostatic hyperplasia（BPH） with bladder stones.Methods 108 patients were first given holmium laser treatment with bladder stones,and then given TURP treatment for BPH.Results Holmium laser lithotripsy duration were 10 to 65 minutes,with an average duration of 31 minutes and TURP duration were 35 to 115 minutes,with an average of 54 minutes.1 patient underwent postoperative bleeding and was given secondary treatment of endoscopic hemostasis,and the remaining patients showed no obvious bleeding;none of the 108 patients showed intraoperative and postoperative transurethral resection syndrome,bladder perforation,residual stones,urethral stricture or other complications.All the patients maintained normal voiding for 5-7 days after catheter removal.7 cases showed temporary incontinence and were fully recovered after treatment.In recheck for 3 months after surgery,no bladder stone recurrence case was reported.International prostate symptom scores of the patients dropped from（21.6±4.7） points to（6.9±1.1） points（P0.01）,quality of life score decreased from（5.4±0.9） points to（2.2±0.6） points（P0.01）,and maximum flow rate increased from（6.9±1.4） mL/s to（16.8±2.3） mL/s（P0.01）.Conclusion TURP combined with holmium laser treatment is both save and effective in the treatment of BPH with bladder stones.It has less invasive,faster recovery,fewer complications,shorter hospital stay and lower costs,and it is gradually accepted by more elderly male patients.