合并前列腺增生症的膀胱结石的手术方式选择

Management methods for bladder stone with benign prostatic hyperplasia

目的探讨良性前列腺增生症合并>3 cm膀胱结石的手术方式选择。方法回顾性分析罗定市人民医院良性前列腺增生症合并膀胱结石患者的临床资料,按膀胱结石碎石取石方法不同分为两组,试验组:耻骨上小切口膀胱切开取石+经尿道前列腺电切术(TURP);对照组:经尿道腔内碎石取石+TURP。统计比较两组患者的一般临床资料,术中评价指标和术后膀胱结石残留及并发症发生情况。结果 126例患者纳入研究,所有患者手术均成功,试验组30例,对照组96例(气压弹道碎石47例,钬激光碎石49例)。两组患者年龄、结石直径、前列腺大小、术前IPSS评分和QOL评分均无统计学差异(P>0.05)。试验组碎石取石时间和总手术时间均较对照组短,差异具有统计学意义(P<0.001)。试验组所有患者术后复查KUB无结石残留;对照组患者术后复查KUB提示结石残留9例,其中气压弹道碎石组4例,钬激光组5例。两组患者均无电切综合征、大出血中转开放手术或二次手术等严重并发症发生。结论耻骨上小切口膀胱切开取石+TURP治疗前列腺增生合并>3 cm膀胱结石安全有效,尤其是合并膀胱小梁小室者,可缩短手术时间,减少术后膀胱结石残留发生率,值得临床推广。

ObjectiveTo explore the choice of operation method for bladder stone （〉3 cm） with benign prostatic hyperplasia.Methods A retrospective record study was conducted of patients with bladder stones complicated with benign prostatic hyperplasia, categorized by the method of Gravel method. Study group： suprapubic small cut method＋TURP; control group： transurethralmethod＋TURP. Patient demographics, baseline characteristics, and operative and postoperative outcomes were compared.Results 126 patients included study （study group： 30, control group： 96）, and all operations were successful. No significant difference was observed between groups in age, cumulative stone diameter, and prostatic volume（P〉0.05）. Patients undergoing suprapubic small cut method had shorter stone removal time and total operative time（P〈0.001）. Residual stones were more commonly in the control group than in the study group （study group： 0, control group： 9 cases）. No seriously complications were recorded.Conclusion Suprapubic small cut method in combination with TURP is safe and effective for the management of bladder stone （〉3 cm） with benign prostatic hyperplasia, especially combined with diverticula, leading to decreased stone residual rate and operative time, which deserves further clinical promotion.