铥激光联合第四代EMS碎石清石系统同期治疗高危BPH合并膀胱结石的疗效分析

Therapeutic effect of thulium laser combined with fourth-generation EMS device in treating benign prostatic hyperplasia complicated by bladder calculus

目的：探讨经尿道铥激光联合第四代EMS碎石清石系统同期治疗高危前列腺增生（BPH）并发膀胱结石的疗效及安全性。方法：回顾性分析2011年2月-2013年4月我院收治的38例高危BPH合并膀胱结石患者临床资料,所有患者均首先应用第四代EMS碎石清石系统粉碎并清除结石,再用铥激光汽化切除增生前列腺组织。分别统计碎石手术时间及总体手术时间,观察术中及术后并发症发生情况。比较患者手术前后国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）、膀胱剩余尿量（RUV）的变化。结果：38例患者均手术成功,术中、术后未出现明显并发症,碎石时间平均23min,手术总体时间平均110min,拔除尿管后患者均排尿畅,无尿失禁。术后随访6个月,IPSS评分由术前（24.15±2.90）降至（7.18±3.32）,QOL评分由术前（6.21±2.03）分降至（1.11±1.42）分,差异有统计学意义（P〈0.01）;Qmax由术前（6.71±2.02）ml/s增至术后（13.20±1.97）ml/s,RUV由术前（15.64±7.33）ml降至术后（6.18±6.92）ml,差异有统计学意义（P〈0.01）。结论：联合应用铥激光及第四代EMS碎石清石系统治疗BPH伴膀胱结石具有并发症少、疗效确切的优点,尤其适合在高龄、体质差、基础疾病多的患者间推广。

Objective： To evaluate the clinical efficacy and safety of thulium laser combined with fourth-generation EMS device for the treatment of benign prostatic hyperplasia （BPH） complicated by bladder calculus. Method： A retrospective study was conducted on 38 patients in our hospital from February 2011 to April 2013. Fourth-generation EMS device was firstly used for all patients, and then thulium laser was used in treating BPH. We observed the perioperative data and the incidence of complications. All the patients＇ IPSS score and quality of life （QOL） score were collected. A 6-month follow up was taken. We compared pre- and post-operative Q max and residual urine volume （RUV） to evaluate the effectiveness. Result： All operations were successful. All patients regained normal urination and no urinary incontinence was found after extubation of the urinary catheter. Mean time of lithotripsy was 23 min, and the total mean operation time was 110 min. No serious complications occurred in the operations. The improvement of IPSS and QOL scores in patients were significant （ P 〈0.01）. Qmax increased from （6. 71±2.02） ml/s to （13.20±1. 97） ml/s after postoperative six months. RUV decreased from （15.64± 7.33） ml to （6. 18 ± 6.92） ml after postoperative six months. Moreover, IPSS score decreased from （24.15 ± 2.90） to （7.18±3. 32）. QOL score decreased from （6. 21±2. 03） to （1. 11±1.42）. All showed significant difference （ P 〈0.01）. Conclusion： Thulium laser combined with fourth-generation EMS device can safely and effectively treat BPH complicated by bladder calculus especially for patients with older age, weak constitution and underlying diseases.