TUPKEP联合膀胱切开取石治疗前列腺增生合并膀胱多发(大)结石疗效观察

The Curative Effect Observation of the Operation Which TUPKEP Combined with Bladder Lithotomyfor Prostatic Hyperplasia and Multiple Calculi(Large)

目的：探讨经尿道前列腺等离子剜除（TUPKEP）联合膀胱切开取石治疗前列腺增生合并膀胱多发（大）结石的疗效。方法：回顾性分析46例在本院行经尿道前列腺等离子剜除术联合膀胱切开取石治疗前列腺增生合并膀胱多发（大）结石病例的临床资料。结果：46例均同期一次手术成功，取石成功率100％。手术时间60～155 min，平均（90.54±19.75）min；出血量50～300 mL，平均（150.42±55.46）mL；术后住院时间7～9 d，平均（7.53±0.68）d。全部患者无手术死亡，无术中、术后大出血，无输血，无膀胱穿孔、前列腺电切综合征（TURS）、尿瘘、切口感染等并发症发生。术后随访6～24个月，平均（16.76±5.11）个月， IPSS、QOL、PVR均较术前明显改善，比较差异有统计学意义（P〈0.05），其中IPSS由术前平均（26.48±2.54）分降至（5.63±1.22）分，QOL由术前平均（4.63±1.12）分下降至（1.23±0.94）分，PVR由术前平均（208.38±35.53）mL下降至（13.52±3.47）mL。且全部排尿通畅，无真性尿失禁、膀胱结石复发及尿道狭窄发生。结论：同期行TUPKEP联合膀胱切开取石治疗前列腺增生合并膀胱多发（大）结石具有安全、方法简单、创伤小、效果好等优点，尤其适合于前列腺体积较大、合并膀胱多发大结石及合并基础病的高龄高危患者，疗效肯定，安全性高，值得推广。

Objective：To discuss the curative effect of the operation which TUPKEP combined with bladder lithotomy for prostatic hyperplasia with bladder multiple calculi（large）. Method：The operation clinical data which TUPKEP combined with bladder lithotomy for prostatic hyperplasia with bladder multiple calculi（large）of 46 cases were reviewed. Result：There were 46 cases of the operation which TUPKEP combined with bladder lithotomy for prostatic hyperplasia with bladder multiple calculi（large）were successful simultaneous therapy,the success rate of lithotomy was 100%. Operation time was 60-155 min,average（90.54±19.75）min. The bleeding was 50-300 mL,average （150.42±55.46）mL. The patients were in hospital 7-9 days,average（7.53±0.68）days after operation. No patient dead in operation or hemorrhage or blood transfusion or bladder perforation or（TURS）or urinary fistula or infection of incision complications. The time follow-up was 6-24 months,average（16.76±5.11）months,IPSS,QOL,PVR was improved before operation,a statistically significant difference（P〈0.05）,IPSS from preoperative average（26.48±2.54） points to（5.63±1.22）points,QOL from preoperative average（4.63±1.12）points to（1.23±0.94）points,PVR from preoperative average（208.38±35.53）mL to（13.52±3.47）mL. All patients were urinate unobstructed with no really urinate incontinence or no bladder calculi recurrence or urethral stricture. Conclusion：TUPKEP combined with bladder lithotomy for benign prostatic hyperplasia with bladder multiple calculi（large）simultaneous therapy is safety and simple method with good effect and little trauma,especially fit for the patients which aged high-risk with larger bladder prostate and multiple stones and other basis of disease.