碎石术辅助白拟排石方对合并膀胱结石的良性前列腺增生患者下尿路症状的改善作用

To improve the effect of Chinese herbal decoction on patients with benign prostatic hyperplasia complicated with bladder stones of lower urinary tract symptoms after lithotripsy of bladder

目的探讨碎石术辅助自拟排石方对合并膀胱结石的良性前列腺增生（benign prostatic hyperplasia，BPH）患者下尿路症状的改善作用。方法纳入72例BPH合并膀胱结石的患者并按病历尾号随机分为辅助治疗组（35例）和非辅助治疗组（37例）。非辅助治疗组于碎石术后膀胱持续冲洗1周，口服坦索罗辛与非那雄胺片1周；辅助治疗组在碎石术术前2d开始服用自拟排石方，共2周。检测和评价治疗前后最大尿流率（maximum urinary flow rate，Qmax）、残留尿量（residual urine volume，RU）以及国际前列腺症状评分（International Prostate SymptomScore，IPSS）和生活质量（Quality of Life，QOL）。比较2组尿常规恢复正常和尿管留置时间。半年后随访尿瘘、尿失禁和膀胱结石复发。结果治疗后，辅助治疗组1PSS评分[（12．9±4．5）分比（15．7±3．9）分；t=2．826，P=0．006]和RU[（47．3±9．2）ml比（58．4±11.3）ml；t=4．556，P〈0．001]显著低于非辅助治疗组，Qmax显著高于非辅助治疗组[（30.4±4．7）ml／s比（21．4±3．9）ml／s；t=8．862，P〈0．001]。辅助治疗组尿管留置时间[（5．7±2．1）d比（8．1±2．2）d；t=4．730，P〈0．001]和尿常规恢复时间[（6．9±2．3）d比（10．2±3．1）d；t=5．106，P〈0．001]均较非辅助治疗组显著缩短。随访6个月显示辅助治疗组尿失禁发生率[2．9％（1／35）比18．9％（7／37）；x2=4．698，P=0．030]和结石复发率[5．7％（2／35）比24．3％（9／37）；x2=4．813，P=0．028]均显著低于非辅助治疗组。辅助治疗组总有效率显著高于非辅助治疗组[62．9％（22／35）比29．7％（11／37）；x2=6．672，P=0．011]。结论碎石术辅助白拟排石方治疗可降低合并膀胱结石的BPH患者IPSS评分和RU，提高Qmax，减少尿失禁和膀胱结石复发，改善下尿路症状。

Objective To evaluate the improvement of lower urinary tract symptoms in benign prostatic hyperplasia （BPH） patients with bladder calculi by lithotripsy and adjuvant traditional Chinese decoction. Methods A total of 72 BPH patients with bladder calculi were recruited and randomly divided into the non-adjuvant treatment group （37 patients） and the adjuvant treatment group （35 patients）. The adjuvant treatment group received adjuvant traditional Chinese decoction from 2 days before lithotripsy for 2 weeks. The maximum urinary flow rate （Qmax）, residual urine volume （RU）, International Prostate Symptom Score （IPSS） and Quality of Life （QOL） were assessed before and after the treatment. The time of urine routine returned to normal and the indwelling time of catheter were compared between two groups. Urinary incontinence and recurrent bladder calculi were followed up for 6 months. Results After the treatment, the score of the IPSS （12.9 ± 4.5 vs. 15.7 ± 3.9; t=-2.826, P=0.006） and the RU （47.3 ± 9.2 ml vs. 58.4 ± 11.3 ml; t=4.556, P〈0.001） in the adjuvant treatment group were significantly lower than those in the non-adjuvant treatment group, and the Qmax （30.4 ± 4.7 ml/s vs. 21.4 ± 3.9 ml/s; t=8.862, P〈0.001 ） was significantly higher. The indwelling time of catheter （5.7 ± 2.1 d vs. 8.1 ± 2.2d; t=4.730, P〈0.001） and the time of urine routine returned to normal （6.9 ± 2.3 d vs. 10.2 ± 3.1 d; t=5.106, P〈0.001） in the adjuvant treatment group were significantly shorter than those in the non-adjuvant treatment group. The 6-month follow-up showed that the incidence of urinary incontinence （2.9% vs. 18.9%; x2=4.698, P=0.030） and recurrent bladder calculi （5.7% vs. 24.3%; x2=4.813, P=0.028） in the adjuvant treatment group were significantly shorter than those in the non-adjuvant treatment group, and the total effective rate was significantly higher （62.9% vs. 29.7%; X2=6.672, P=0.011）. Conclusions Lithotripsy and adjuvant traditional Chinese decoction can reduce the IPSS score and RU, increase Qrnax, decrease urinary incontinence and recurrent bladder calculi, and improve lower urinary tract symptoms in BPH patients with bladder calculi. [Key words] Prostatic hyperplasia; Urinary bladder calculi; Lower urinary tract symptoms; Lithotripsy; Drugs, Chinese herbal