经耻骨上膀胱切开取石术联合经尿道前列腺汽化电切术治疗前列腺增生症合并膀胱结石的效果观察

Effect of suprapubic Hthocystotomy combined with transurethrai resection of the prostate in the treatment of prostatic hyperplasia complicated with bladder stones

目的 观察经耻骨上膀胱切开取石术联合经尿道前列腺汽化电切（ＴＵＲＰ）术治疗前列腺增生症（ＢＰＨ）合并膀胱结石的效果，总结手术技巧。方法 选取ＢＰＨ合并膀胱结石患者８２例，采用随机数字表法分为两组，每组４１例，对照组应用ＴＵＲＰ联合气压弹道碎石治疗，研究组应用ＴＵＲＰ联合切开取石术治疗，对比两组患者的治疗效果。结果 研究组的出血量、碎石取石时间、总的手术时间［（６４．１±１．３）ｍＬ、（１２６±２．５）ｍｉｎ、（６３．１±１．６）ｍｉｎ］均显著低于对照组［（９２．１±１．８）ｍＬ、（２３．６±２．１）ｍｉｎ、（８３．１±１．７）ｍｉｎ，ｔ＝１７２９４、１１３９１、１５．１２５，均Ｐ＜０．０５］；研究组患者的最大尿流率（Ｑｍａｘ）（１８．４±４．３）ｍＬ／ｓ，显著高于对照组的（９．５±５．１）ｍＬ／ｓ（ｔ＝１５．２９４，Ｐ＜０．０５）；同时国际前列腺症状（ＩＰＳＳ）评分（８．８±１．７）分、残余尿量（ＲＵＶ）（１５．８±５．３）ｍＬ及生活质量评分（ＱＯＬ）（１．４±０．６）分，均显著低于对照组的（１７．３±２．８）分、（４２．５±６．１）ｍＬ、（３．６±１．８）分（ｔ＝１５３９１、２２．１２５、１２．９３５，均Ｐ＜０．０５）；研究组患者术后并发症发生率（７．１％）显著低于对照组（４０．５％）（χ２＝６．９３５，Ｐ＜０．０５）。结论 ＢＰＨ合并膀胱结石患者联合应用ＴＵＲＰ以及切开取石术治疗，有利于提高治疗效果，降低并发症发生风险。

Objective To observe the effect of suprapubic lithocystotomy combined with transurethral resection of the prostate （TURP） in the treatment of benign prostatic hyperplasia （BPH） complicated with bladder stones, and to summarize the surgical technique. Methods Eighty - two BPH patients with bladder stones were selected, and they were randomly divided into two groups according to the digital table,with 41cases in each group. The control group received TURP combined with pneumatic lithotripsy. The study group was treated with TURP combined with lithocystotomy. The treatment effect was compared between the two groups. Results The blood loss, duration of stone surgery and total operative time in the study group were （ 64. 1 ± 1.3 ） mL, （ 12.6 ± 2.5 ） min, （ 63.1 ± 1.6 ） min, respectively,which were significantly lower than those in the control group [ （92.1 ± 1.8 ） mL, （ 23.6 ± 2.1 ） min, （ 83.1 ± 1.7 ） min, t = 17. 294,11.391,15. 125, all P 〈 0.05 ]. The maximal urinary flow rate （ Qmax ） of the study group was （ 18.4 ± 4.3 ） mL/s, which was significantly higher than （9.5 ± 5.1 ） mL/s of the control group （ t = 15. 294 ,P 〈0.05 ）. The international prostate symptoms score （IPSS）, residual urine volume （RUV）, quality of life （QOL） score in the study group were （8.8 ± 1.7 ） points, （ 15.8 ± 5.3 ） mL, （ 1.4 ± 0.6 ） points, which were signifi- cantly lower than those in the control group [ （ 17.3 ± 2.8 ） points, （42.5 ± 6. 1 ） mL, （ 3.6 ± 1.8 ） points ] （ t = 15.391,22.125,12. 935, all P 〈 0.05 ）. The incidence rate of postoperative complications in the study group （7.1% ） was significantly lower than 40.5 % in the control group （ X2 = 6. 935, P 〈 0.05 ）. Conclusion TURP combined with lithocystotomy in the treatment of BPH complicated with bladder stones is helpful to improve the therapeutic effect and reduce the risk of complications.