等离子电切镜联合钬激光一期治疗前列腺增生症合并膀胱结石

Combination of Plasmakinetic Vaporized Resectoscope With Holmium Laser at Stage Ⅰ in the Treatment of Benign Prostatic Hyperplasia Complicated With Bladder Stones

目的探讨经尿道等离子电切联合钬激光一期治疗前列腺增生症并膀胱结石的安全性、可行性。方法 68例前列腺增生症合并膀胱结石患者,先行经尿道膀胱结石钬激光碎石术,随后行等离子前列腺电切术。统计分析碎石时间、前列腺电切时间、术中出血量、膀胱冲洗时间、术后留置尿管时间、术后最大尿流率、膀胱残余尿量、结石清除率、术中术后并发症发生率等。结果 68例手术全部成功,膀胱结石平均碎石时间(27.8±8.5)min、前列腺电切平均时间(72.8±18.6)min、平均术中出血量(115.8±20.6)ml、平均膀胱冲洗时间(3.1±0.8)d、平均术后留置尿管时间(7.3±1.6)d、平均术后最大尿流率(16.3±1.9)ml/s、平均膀胱残余尿量(12.7±3.1)ml、结石清除率100%。无电切综合征、膀胱穿孔、下肢深静脉血栓形成、尿道狭窄等并发症。结论经尿道等离子电切联合钬激光一期治疗前列腺增生症合并膀胱结石是安全、可行,具有疗效确切、创伤小、恢复快、操作简单等优点,对于较大的膀胱结石(直径>4 cm)也有较好的疗效。

Objective To explore the safety and feasibility of the combination of plasma kinetic vaporized resectoscope with holmium laser at stage Ⅰ in the treatment of Benign prostatic hyperplasia（BPH） with bladder stones. Methods A total of 68 patients with BPH and bladder stones underwent combined transurethral holmium laser lithotripsy and transurethral plasma resection of prostate. A statistical analysis of the mean lithotripsy time,the mean of resection of prostate,the mean intraoperative estimated blood loss,the mean time of bladder irrigation,the mean time of withdrawal of urethral catheter,the mean maximum urine flow rate,the mean residual urine volume in bladder,the stone clearance rate and the rate of complications during and after operation were performed. Results The procedure was succesfully completed in all the patients. The mean lithotripsy time was（27.8±8.5）min,the mean of resection of prostate was（72.8±18.6） min,the mean intraoperative estimated blood loss was（115.8±20.6） ml,the mean time of bladder irrigation was（3.1±0.8） d,the mean time of withdrawal of urethral catheter was（7.3±1.6） d,the mean maximum urine flow rate was（16.3±1.9） ml/s,the mean residual urine volume in bladder was（12.7±3.1） ml,the stone clearance rate was 100%. There were no complications such as transurethral resection syndrome,bladder perforation,deep venous thrombosis of lower extremity and urethrostenosis. Conclusion Combination of plasma kinetic vaporized resectoscope with holmium laser is effective and safe at stage Ⅰ in the treatment of Benign prostatic hyperplasia with bladder stones,with the advantages of curative effect,minimally invasive,rapid recovery and easyto-operate. It is also effective for larger bladder stones（4 cm in diameter）.