两种方法治疗高龄、高危BPH合并膀胱多发结石的疗效比较

Two different methods for the treatment of high-risk elderly patients with BPH complicated with multiple bladder calculi

目的:探讨耻骨上小切口膀胱切开取石联合TUVP+TURP与钬激光碎石+TURP两种方法治疗高龄、高危BPH合并膀胱多发结石的安全性和有效性。方法:回顾分析102例高龄、高危BPH合并膀胱多发结石患者的临床资料,按患者治疗意愿分为观察组(耻骨上膀胱切开取石联合TUVP+TURP组)53例和对照组(钬激光碎石+TURP组)49例,对两组术中、术后相关指标值进行比较。结果:102例患者均顺利完成手术,所有患者均获得随访,随访时间7~13个月,平均8.4个月。两组取石、碎石时间分别是(15.8±7.5)min、(51.6±18.4)min(P<0.01),总手术时间分别为(78.2±7.3)min、(138.4±12.6)min(P<0.01),术中出血量分别为(126.4±26.7)ml、(184.2±28.3)ml(P<0.01),组间比较差异有统计学意义;两组术后下肢静脉血栓形成、留置尿管时间、住院时间比较差异有统计学意义(P<0.01),术后并发症比较差异无统计学意义(P>0.05);两组术后6个月RUV、Qmax、IPSS、QOL与术前比较均明显改善(P<0.01),组间比较差异无统计学意义(P>0.05)。结论:两种方法治疗高龄、高危BPH合并膀胱多发结石患者各有优缺点,钬激光碎石+TURP方法手术时间长,术中出血较多,术后个别患者下肢静脉血栓形成,但患者留置尿管及住院时间短。耻骨上小切口膀胱切开取石联合TUVP+TURP手术时间短,术中出血较少,术后未见下肢静脉血栓形成,手术相对安全,但留置尿管时间及住院时间长。

Objective: To explore the safety and efficacy of suprapubic cystolithotomy combined with TUVP+TURP and Holmium laser lithotripsy+TURP for high-risk ederly patients with benign prostatic hyperplasia(BPH) complicated with multiple bladder calculi. Methods: A retrospective study was conducted on the total of 102 high-risk elderly patients with BPH with multiple baldder calculi. The patients were randomly given suprapubic cystolithotomy combined with TUVP+TURP(n = 53) as observation group, or Holmium laser lithotripsy+TURP(n=49) as control group. The intraoperative and postoperative related indicators were compared between the two groups. Results : All operations were successfully performed. All patients were followed up for 7 to 13 months, an average of 8. 4 months. In observation group and control group,the lithotripsy time was(15. 8±7. 5) min and(51. 6± 18. 4) min(P<0. 01); the mean operation time was(78. 2 ±7. 3)min and(138. 4± 12. 6) min(P<0.01); postoperative blood loss was(126. 4±26. 7) mL and(184. 2±28. 3) mL(P<0. 01), respectively. All patients were followed up for 6 months. RUV, Q_(max),IPSS, QUV were obviously improved postoperatively in all patients as compared with the preoperative data, but there was no significant difference between the two group. Conclusions : The two methods have the advantages and disadvantages in the treatment of the elderly and high risk BPH patients with bladder multiple calculi. The holmium laser lithotripsy + TURP method has a long operation time and more intraoperative bleeding, very few patients had thrombosis of lower limbs, and indwelling catheter time and hospital stay are short. The small incision of the suprapubic cystolithotomy combined with TU VP + TURP had shorter operative time,less intraoperative bleeding,and there was no thrombosis of the lower limbs after operation. The operation was relatively safe,but the time of indwelling catheter and the length of hospital stay were long.