经尿道前列腺等离子剜除术联合气压弹道碎石术治疗80 mL以上前列腺增生并膀胱结石的临床效果

Clinical efficacy of transurethral plasmakinetic enucleation of prostate combined with pneumatic lithotripsy in the treatment of benign prostatic hyperplasia more than 80 mL and bladder stones

目的探讨经尿道前列腺等离子剜除术(TPKEP)联合气压弹道碎石术治疗80mL以上前列腺增生(BPH)并膀胱结石的临床疗效。方法将确诊为BPH合并膀胱结石的104例患者依据手术方式分为经尿道前列腺等离子剜除术联合气压弹道碎石术组(56例)与经尿道前列腺等离子剜除术联合耻骨上小切口切开取石术组(48例)。比较两组手术时间、膀胱冲洗时间、留置导尿时间、血红蛋白降低指数、术中出血量、术后住院时间、住院费用及近期并发症,并对两组患者术后3个月最大尿流率(Qmax)、生活质量(QoL)评分、残余尿量(PVR)、国际前列腺症状评分(IPSS)、前列腺特异抗原(PSA)及梗阻评分的变化值进行比较。结果在膀胱冲洗时间、留置导尿时间、血红蛋白降低指数、术中出血量和术后住院时间这几个指标观察组均低于对照组,差异具统计学意义(t=-4.351、-2.762、-7.639、-6.602、-4.710,P<0.05),而住院费用则观察组高于对照组(t=2.912,P<0.05);观察组术后3个月Qmax增加值、PSA下降值及梗阻下降值均高于对照组(t=3.802、1.239、4.159,P<0.05);观察组患者术后泌尿系感染、二次出血发生率均低于对照组(χ^2=8.844、0.006,P<0.05)。结论经尿道前列腺等离子剜除术联合气压弹道碎石术治疗80mL以上BPH并膀胱结石具有创伤小、出血少、恢复快且安全有效等优点,值得临床推广使用。

Objective To study the efficacy of transurethral plasmakinetic enucleation of prostate(TPKEP)combined with pneumatic lithotripsy in the treatment of benign prostatic hyperplasia(BPH)more than 80 m L and bladder stones.Methods Total of 104 patients of BPH combined with bladder stones treated in our hospital were randomly divided into two groups,with 52 patients in either group.The patients in the observation group was treated by transurethral plasmakinetic enucleation combined with pneumatic lithotripsy,the patients in the control group by transurethral plasmakinetic enucleation of the prostate and suprapubic small incision to remove stones.The operation time,bladder irrigation time,intubation time,drop in hemoglobin,blood loss,postoperative hospitalization time,hospitalization expenses,early complications and the postoperative 3 months change value of maximum urinary flow rate(Qmax),quality of life(QOL)score,postvoid residua(PVR),international prostate symptom score(IPSS),prostate specific antigen(PSA),obstruction scores of the two groups were compared.Results Results The bladder irrigation time,intubation time,drop in hemoglobin,blood loss,postoperative hospitalization time,drop in hemoglobin were significant lower in the observation group than those in the control group(t=-4.351,-2.762,-7.639,-6.602,-4.710,P<0.05).The hospitalization expenses in the observation group was significantly higher than that in the control group(t=2.912,P<0.05);The increase of Qmax,the decline of PSA level and the obstruction s cores in the observation group were higher than those in the control group at postoperative 3 months(t=3.802,.239,4.159,P<0.05).The rate of urinary infection and secondary hemorrhage in the observation group were lower than that in the control group(χ^2=8.844、0.006,P<0.05).Conclusion Conclusion Transurethral plasmakinetic enucleation combined with pneumatic lithotripsy have the advantage of less invasion,less bleeding,faster recovery,save and effective in the treatment of BPH more than 80 m L and bladder stones,which is worth for clinical use.