经尿道碎石术和经尿道前列腺电切术治疗良性前列腺增生伴膀胱结石

【】　目的　探讨良性前列腺增生（benignprostatichyperplasia，BPH）伴膀胱结石的有效腔内治疗方法。〖HTH〗方法　2003年6月-2009年12月，使用F26号电切镜外鞘作为撑开器，气压弹道和（或）钬激光粉碎膀胱结石，经尿道前列腺电切术（transurethralresectionoftheprostate，TURP）治疗BPH伴膀胱结石86例。患者年龄58～83岁，平均68.6岁；病程2～8年，平均5.2年。术前患者国际前列腺症状评分（internationalprostatesymptomscore，IPSS）为（24.6±3.9）分，生活质量（5.7±0.6）分；前列腺重量（46.5±6.8）g，剩余尿量（185±58）mL，最大尿流率（5.7±2.3）mL/s。　结果　86例均一次手术成功。碎石时间为16~58min，平均38min；前列腺电切时间40~100min，平均65min。术中无并发症发生。术后5~8d拔除尿管，平均6.5d。术后4例出现前尿道狭窄，经治疗后痊愈。54例获随访，随访时间2~6个月，平均3个月。术后2个月，54例最大尿流率升至（18.5±4.1）mL/s，剩余尿量下降至（16±22）mL，IPSS评分下降至（7.8±1.6）分，生活质量（2.5±0.3）分，与术前比较差异均有统计学意义（P<0.01）。　结论　经尿道碎石术和TURP一次性治疗BPH伴膀胱结石安全、有效、经济。【Abstract】　Objective　Toexploreaneffectiveendourologictreatmentmethodforbenignprostatichyperplasia(BPH)withbladdercalculi.　Methods　FromJune2003toDecember2009,ballisticorholmiumlaserlithotripsybyoutersheathresectoscopeandtransurethralresectionoftheprostate(TURP)wereperformedon86patientswithBPHandbladdercalculi.Thepatientsaged58to83yearsold,averagingat68.6years.Durationoftheirdiseasecourserangedfrom2to8years,averaging5.2years.Beforesurgery,theinternationalprostatesymptomscore(IPSS)was24.6±3.9;thescoreofqualityoflife(QOL)was5.7±0.6;prostaticweightwas(46.5±6.8)g;residualurine(RU)volumewas(185±58)mL;andthepeakurineflowrate(Qmax)was(5.7±2.3)mL/s.　Results　Theoperationswerecompletedsuccessfullyinallcaseswithameanlithotripsytimeof38min(16-58minutes)andameanTURPtimeof65min(40-100minutes).Nocomplicationsoccurredduringtheoperation.Urethralcatheterwaswithdrawn5-8daysafteroperation,withameanperiodof6.5days.Fourpatientshadanteriorurethralstrictureafteroperation,butrecoveredthroughtreatment.Fifty-fourpatientswerefollowedupfor2to6monthswithanaveragefollow-uptimeof3months.Twomonthsaftertheoperations,IPSSdecreasedto7.8±1.6;Qmaxincreasedto(18.5±4.1)mL/s;RUdecreasedto(16±22)mLandQOLwas2.5±0.3.Comparedwithpreoperativeconditions,thedifferenceswereallstatisticallysignificant(P＜0.01).　Conclusion　TransurethrallithotripsycombinedwithTURPisaneffective,safeandeconomicaltreatmentforbenignprostatichyperplasiawithbladdercalculi.