不同联合术式治疗重度前列腺增生伴膀胱结石的临床疗效

Clinical effects of different combined surgery on severe prostatic hyperplasia complicated with bladder calculi

目的对比分析两种联合术式治疗重度前列腺增生伴膀胱结石的临床效果。方法选择208例重度前列腺增生伴膀胱结石患者为研究对象，行回顾性分析。按手术方法分组，A组89例患者行经尿道前列腺切除术（TURP）联合气压弹道碎石术，B组119例患者行TURP联合钬激光碎石术。统计对比取石时间、手术时间、碎石成功率、结石排净率、导尿管留置时间、术中及术后并发症情况。结果A组取石时间[（30．1±5．2）min]显著短于B组[（38．8±7．2）min]，手术时间[（137．2±12．8）min]显著长于B组[（125．2±13．8）min]，结石排净率（88．8％，79／89）显著低于B组（96．6％，115／119），手术情况对比差异未见统计学意义。A组膀胱壁损伤4例，术后发热48例，未见其他并发症；B组术后发热63例，榆尿管穿孔2例，3例其他并发症，两组并发症发生率（58．4％VS57．1％）比较差异未见统计学意义（P〉0．05）。结论两种联合术式治疗重度前列腺增生伴膀胱结石的效果均较佳，然而却存在一定差异，术者必须结合实际合理选择手术方案。

Objective To analyze the effects of two kinds of joint operation on severe prostatic hyperplasia complicated with bladder calculi. Methods A total of 208 patients with bladder stones com- plicated with severe hyperplasia of prostate were chose as the research objects, and were retrospectively analyzed. The patients were divided according to the surgery methods, the patients in group A （n = 89） were treated with transurethral plasmakentic vaporization of prostate resection （TURP） combined with pneumatic ballistic lithotripsy, and the patients in group B （n = 119） were treated with TURP combined holmium laser lithotripsy. The lithotomy time, operation time, success rate of gravel, stone clearance rate, catheter indwelling time, intraoperative and postoperative complications were compared. Results Lithoto- my time of group A [ （30. 1 ± 5.2 ）min ] was significantly shorter than that of group B [ （38.8 ± 7.2）minl, the operative time [ （137.2 ± 12. 8） mini was significantly longer than that of group B [ （ 125.2 ±13.8 ） min ], the stone clearance rate （ 88.8%, 79/89 ） was significantly lower than that of group B（96.6%, 115/119）, the operation situation had no other significant difference. Group A had 4 cases of bladder wall injury, 48 cases of postoperative fever, no other complication. Group B had 63 ca- ses of postoperative fever, 2 cases of ureteral perforation, 3 cases of other complications, the complication rates（59.6% vs 57.1% ） were similar between the two groups, there was no significant difference（P 〉 0. 05 ）. Conclusions Two kinds of joint surgery on the therapy of severe prostatic hyperplasia with blad- der calculi are both good, but there are some significant differences, performer must choose surgery com- bined with the actual and reasonable scheme.