经尿道高功率绿激光联合钬激光治疗高龄高危前列腺增生合并膀胱结石

Clinical research on the treatment of benign prostatic hyperplasia patients complicated with bladder calculi with 160W green-light laser photoselective vaporization of prostate and transurethral holmium laser cystolithotripsy

目的探讨经尿道160 W高功率绿激光前列腺汽化术联合经尿道钬激光碎石术治疗高龄高危前列腺增生(BPH)合并膀胱结石的临床疗效。方法 2016年1月至2016年12月我院收治的31例高龄高危BPH合并<2 cm膀胱结石患者纳入研究,全部患者均行经尿道160 W高功率绿激光前列腺汽化术联合经尿道钬激光碎石术。观察手术时间、术中出血量、膀胱冲洗时间、置管时间、术后住院时间及近期并发症。术后第6个月随访,测定术后最大尿流率(Qmax)、残余尿量、国际前列腺症状评分(IPSS)和生活质量(QOL)评分。结果 31例手术均一次成功,均无残留结石。经尿道绿激光前列腺汽化术联合经尿道钬激光碎石术手术时间平均(116.9±45.8)min,其中绿激光前列腺汽化术用时平均(66.8±33.3)min,钬激光碎石术用时平均(51.0±20.0)min。术中出血量(68.6±23.7)ml。置管时间(2.6±0.8)d,术后住院时间(5.7±2.0)d。术中、术后均未见严重并发症。术后第6个月随访,IPSS由术前(21.1±5.8)分下降至(4.2±2.1)分,Qmax由术前(7.5±3.3)ml/s上升为(21.1±2.1)ml/s,QOL评分由术前(5.0±1.2)分下降至(1.4±1.0)分,手术前后各指标比较,差异均有统计学意义( P <0.05)。第6个月复查腹部X线平片,31例患者均未见膀胱结石复发。结论在充分完善围手术期准备和严格控制内科疾病的前提下,经尿道160 W高功率绿激光前列腺汽化术联合经尿道钬激光碎石术可作为高龄高危BPH合并<2 cm膀胱结石患者的手术方法。

Objective To evaluate the clinical effect of 160 W green-light laser photoselective vaporization of prostate (PVP) and transurethral holmium laser cystolithotripsy in treating benign prostatic hyperplasia (BPH) complicated with bladder calculi (<2 cm). Methods The clinical data of 31 high-risk and elderly patients with BPH and bladder calculi who underwent 160 W green-light laser PVP combined with transurethral holmium laser cystolithotripsy in Second Xiangya Hospital from January 2016 to December 2016 were retrospectively analyzed. Data included operative time, intraoperative bleeding volume, intubation time, post-operative hospitalization, complications.Six months after operation, data of peak urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QOL) score were also collected. Results The procedure was successful in all 31 patients with complete stone clearance achieved. The mean operative time was (116.9±45.8) min, and the average operatiing time for PVP was (66.8±33.3) min. The time of stone extraction was (51.0±20.0) min. The mean intraoperative bleeding volume was (68.6±23.7) ml. The mean postoperative indwelling catheter time was (2.6±0.8) d, the mean post-operative hospital stay was (5.7±2.0) d. There were no serious complications such as transurethral resection syndrome, massive hemorrhage in all 31 patients. Six months postoperatively, the mean IPSS decreased from (21.1±5.8) to (4.2±2.1), Q max inecreased from (7.5±3.3) ml/s to (21.1±2.1) ml/s, QOL score decreased from (5.0±1.2) to (1.4±1.0)( P <0.05). No residual stone occurred during the 6 month follow-up. Conclusions With sufficient preoperative, intraoperative, and postoperative management, and the strict control of basic disease, 160 W green-light laser PVP and transurethral holmium laser cystolithotripsy is optimal for high-risk elderly patients with BPH and bladder calculi (<2 cm).