电切镜下钬激光碎石联合前列腺剜除术治疗前列腺增生并膀胱结石的临床分析

CLINICAL STUDY OF HOLMIUM LITHOTRIPSY UNDER RESECTOSCOPE COMBINED WITH PROSTATE ENUCLEATION IN THE TREATMENT OF PROSTATE HYPERPLASIA COMBINED WITH BLADDER CALCULI

目的 评价电切镜下钬激光碎石联合前列腺剜除术治疗前列腺增生并膀胱结石的效果及安全性。方法 我科于2011年9月～2014年9月收治前列腺增生并膀胱结石患者67例,随机分为A组和B组,其中A组32例,B组35例。A组行电切镜下钬激光碎石联合前列腺剜除术（即通过电切镜电切攀通道置入钬激光光纤行膀胱结石钬激光碎石,再行前列腺剜除术）,B组经电切镜外鞘置入输尿管镜钬激光碎石后行前列腺剜除术。统计两组病例之间碎石时间、前列腺剜除时间、血红蛋白下降值、膀胱粘膜损伤程度及膀胱穿孔、拔除尿管后尿失禁和尿潴留的发生率。结果 A组碎石时间少于B组（p〈0.05）,而两组间前列腺剜除时间、血红蛋白下降值、膀胱粘膜损伤程度的差异均无统计学意义（p〉0.05）。两组患者均未发生膀胱穿孔;拔除尿管后均排尿通畅;A组10例和B组11例患者发生暂时性尿失禁（p〉0.05）。结论 电切镜下钬激光碎石联合前列腺剜除术治疗前列腺增生并膀胱结石安全有效,不仅缩短手术时间,还可避免输尿管镜的使用。

Objective To evaluate the effect and security of holmium lithotripsy under resectoscope combined with prostate enucleation in the treatment of patients with prostate hyperplasia combined with bladder calculi. Methods 67 patients with prostate hyperplasia and bladder calculi admitted in our hospital from September 2011 to September 2014 were divided into group A （ n = 32 ） and group B （ n = 35 ） randomly. Group A was treated with holmium lithotripsy under resectoscope combined with prostate enucleation, and group B was with ureteroscopic lithotripsy under resectoscope combined with prostate enucleation. The lithotriptic time, enucleating time, decrease of hemoglobin, and injury of bladder mucosa were recorded. The perforation of bladder, incontinence and rention of urine after removing catheter was also counted. Results The lithotriptic time was shorter in Group A （p 〈 0.05 ）. The differenees in enucleating time, decrease of hemoglobin, and injury of bladder mucosa between two groups were not significant （p 〉 0.05 ）. Perforation of bladder did not occur in both groups. Acute urinary retention did not happen after removing catheter. 10 cases in group A and 11 cases in group B developed temporary incontinence （p 〉 0.05 ）. Conclusion Holmium lithotripsy under resectoscope combined with prostate enucleafion in the treatment of patients with prostate hyperplasia and bladder calculi is safe and effective. The operation time can be shortened and even the operation is ureteroscope free.