前列腺增生症合并膀胱结石的手术方式选择

Management of benign prostatic hyperplasia complicated with bladder calculi

目的探讨良性前列腺增生症合并直径〉3cm膀胱结石的手术方式的选择。方法回顾性分析我院从2008年2月-2014年6月良性前列腺增生症合并膀胱结石患者的临床资料,选取了膀胱结石〉3cm,按膀胱结石碎石取石方式不同分为两组。A组：耻骨上小切口膀胱切开取石联合PKEP。B组：经尿道钬激光碎石取石联合等离子前列腺剜除术（PKEP）。比较两组患者的一般资料、手术时间、出血量、术后膀胱结石残留、并发症发生情况和术后排尿情况。结果 80例患者纳入研究,所有患者手术均成功,A组40例,B组40例,两组患者年龄、结石直径、前列腺大小、术前泌尿系感染及术前国际前列腺症状评分均无统计学意义（P〉0.05）。A组的碎石取石时间和总手术时间较B组短,A组术后泌尿系感染、术中术后出现低体温、术后膀胱结石残留均低于B组,有统计学意义（P〈0.05）。两组均无电切综合征、大出血、二次手术等严重并发症。结论前列腺增生症合并膀胱结石,如膀胱结石直径〉3cm,采用耻骨上小切口膀胱切开取石联合PKEP是安全、有效的方法,可缩短手术时间,减少术后膀胱结石残留,减少术中术后并发症,值得临床推广。

Objective To investigate the operation approach for benign prostatic hyperplasia complicated with bladder calculi.Methods Clinical data of 80 cases of benign prostatic hyperplasia complicated with bladder calculi（3 cm）were retrospective analyzed.The cases were divided them into two groups：group A（n=40）received plasmakinetic enucleation of prostate（PKEP）combined with suprapubic cystolithotomy,while group B（n=40）underwent PKEP combined with holmium laser cystolithotripsy.Data including operation time,bleeding volume,clearance rate of calculi,postoperative complication,postoperative urination were compared between the two groups.Results All operations were successful.There were no significant differences in age,stone diameter,and prostatic volume,preoperative infection or IPSS score between the two groups（P0.05）.Group A had shorter operation time and stone removal time than group B（P0.05）.Group A had fewer occurrence of urinary infection,low temperature,and residual calculi than group B（P0.05）.There were no serious complications such as transurethral resection syndrome（TURS）,massive hemorrhage in both groups.Conclusions PKEP combined with suprapubic cystolithotomy is safe and effective method for the management of benign prostatic hyperplasia with bladder calculi（3cm）,which can shorten operation time,reduce stone residual and postoperative complications.