高危前列腺增生合并膀胱结石行经尿道钬激光碎石及经尿道前列腺电切术的观察

Therapeutic effect observation of transurethral holmium laser lithotripsy and transurethral resec- tion of prostate in treatment of high-risk benign prostatic hypcrplasia with bladder calculi

目的探讨高龄高危前列腺增生（BPH）合并膀胱结石的治疗方法。方法采用经尿道前列腺电切术（TURP）联合电切镜钬激光碎石同期治疗高危BPH合并膀胱结石患者84例。即通过电切攀通道置人钬激光光纤行膀胱结石钬激光碎石，再行TURP治疗。结果84例平均年龄78岁患者均一次性手术成功，取石率为100％。手术时间40-120rain，平均约65min，其中碎石时间5～30min，平均15min。术中无出血、穿孔。TURP术后留置导尿管3～6d，术后住院时间为5～9d，平均6．9d。术后随访3～12个月，无结石复发及尿道狭窄等并发症。结论采用TURP加钬激光碎石术治疗高危BPH合并膀胱结石具有手术时间短，创伤小及安全性高等优势。特别是对高危前列腺增生症患者合并膀胱较大结石、多发结石更具优势。

Objective To investigate the treatment of senile and high-risk benign prostatic hyper- plasia（BPH） with bladder calculi. Methods A total of 84 patients with high-risk BPH and bladder calculi underwent combined transurethral holmium laser lithotripsy and transurethral resection of prostate （TURP）. Optical fiber of holmium laser was introduced into the bladder through the aisle of resectoscope to perform cystolithotripsy ,which was followed by TURP. Results All 84 patients with an average age of 78 years had one-time surgery successfully with a stone clearance rate of 100%. The operative time was 40 ~ 120 min with an average of about 65rain. The time of the lithotripsy was 5 - 30 rain with an average of 15 rain. No bladder bleeding or perforation occurred. The catheterization time after TURP was 3 -6 d, the postoperative hospital stay was 5 - 9 d with an average of 6.9 d. No bleeding or difficulty urinating oc- curred. The patients were followed up for 3 - 12 months with no complications such as stone recurrence or urethral stricture. Conclusion In the treatment of high-risk BPH and bladder calculi,TURP plus holmium laser lithotripsy has the advantages of short operative time, minimal invasion and good security, especially for high-risk BPH with large or multiple bladder stones.