良性前列腺增生合并膀胱结石同期处理的两种术式比较

1、良性前列腺增生合并膀胱结石同期处理的两种术式比较         09-08-16 11:16:00     作者：杨正家 李新德    编辑：studa20【摘要】  目的比较良性前列腺增生(BPH)合并膀胱结石同期处理的两种术式及疗效。方法63例患者随机分为两组,开放手术组（32例）采用经耻骨上小切口膀胱切开取石,再行经尿道前列腺电切术(TURP)。钬激光碎石组（31例）先经尿道钬激光碎石,再行TURP。观察两组患者术中取

2、石时间、术后膀胱冲洗时间、留置导尿管时间、住院时间、住院费用及术后疗效。结果与钬激光碎石组比较，开放手术组术中取石时间、住院费用具有明显优势，两组差异均有统计学意义（t 分别2.89、17.87，P均0.05）；而术后膀胱冲洗时间、留置导尿管时间、住院时间比较，钬激光碎石组比开放手术组具有优势，两组差异均有统计学意义（t 分别2.21、8.04、2.19，P均0.05）。两组患者均一次取石成功。术后随访335个月,未见结石复发、尿失禁及尿道狭窄等并发症,国际前列腺症状评分(IPSS)、最大尿流率和残余尿量较术前均有显著改善。结论耻骨上小切口膀胱切开取石联合TURP、钬激光碎石联合TURP均可对

3、BPH合并膀胱结石进行同期处理,是为安全有效的方法。 【关键词】  良性前列腺增生； 膀胱结石； 经尿道前列腺电切术； 钬激光碎石术          To compare the safety and the clinical efficacy of two means of simultaneous treatment for benign prostate hyperplasia (BPH) and bladder stone. Methods   Sixty-three cases of

4、 BPH and bladder stones were randomly divided into 2 groups: they were treated by combining mini-incisions cystolithotomy (group A) ,transurethral eletroresection with holmium laser (group B). TURP followed after the removal of stone. The removal of stone time, bladder irrigation time, catheterizati

5、on time, hospital stay , hospital expenses and therapeutic effects were surveyed. Results   Compared with group B, the removal of stone time, hospital cost were significantly superiority in group A(t=2.89,17.87, P<0.05).But compared with group A, the bladder irrigation time, catheteriza

6、tion time, hospital stay were significantly superiority in group B(t=2.21,8.04,2.19, P<0.05). The procedures were successful in all cases, a follow up of 3 to 35 months found a good outcome in both groups. All the patients had normal micturation after the urethral catheter was withdrawn and no se

7、vere complication. IPSS, Qmax and RUV were significantly improved in both groups. Conclusion   The results showed that the two therapies of BPH with bladder stones were safe and effective.      benign prostatic hyperplasia;bladder stone;transurethral resection of the pr

8、ostate;holmium laser    全性进行比较。现报道如下。    1资料与方法    1.1一般资料选择2005年1月至2008年3月浙江大学医学院附属邵逸夫医院泌尿外科和杭州市余杭区中医院泌尿外科收治BPH并膀胱结石老年患者63例。年龄6492岁,平均（75.51±12.35）岁。病史3个月5年,伴有不同程度的尿频、尿急、尿痛、血尿。尿潴留18例,合并高血压13例、冠心病6例、慢性支气管炎伴肺气肿6例、肺功能检查有轻度阻塞性通气功能障碍5例、曾有脑梗死史3例、糖尿病6例、慢性肾

9、功能不全3例。术前国际前列腺症状评分(international prostate symptom score, IPSS)均17分，最大尿流率10 ml/s,残余尿量50 ml。全部患者行B超及腹部平片检查,结石直径1.25.0cm，结石最少1枚，最多11枚。前列腺体积25.3132.6cm3，前列腺增生度9例、度26例、度21例、度7例。术后病理组织检查均为良性前列腺增生。随机分为两组：开放手术组（n=32）；钬激光碎石组（n=31）。两组一般资料比较见表 1，两组患者年龄、前列腺、结石大小比较，差异均无统计学意义（P均0.05）。    1.2方法术前分别予

10、留置导尿,控制血压、血糖,改善心肺功能,抗感染及对症治疗,患者术前均口服爱普列特片2周以上以减少手术出血。全部选用硬脊膜外阻滞麻醉,部份辅助基础麻醉,常用的电切冲洗液为5%甘露醇液,电切冲洗液的温度保持在室温。    开放手术组: 取膀胱截石位,术者先经尿道直视插入电切镜,观察尿道、前列腺增生情况,膀胱结石的大小、数量和位置, 有无合并膀胱憩室。用冲洗液胀满膀胱,助手在耻骨联合上2cm 处向上做一纵行切口,长34cm,按解剖层次进入,电刀切开膀胱前壁,用卵圆钳从膀胱切口依次将结石取出。对于较小的结石可先Ellik冲洗器将其冲出,取尽结石后,留置膀胱造瘘管,在低压状

11、态下继续行TURP。    钬激光碎石组:尿道内置入F21膀胱镜鞘后置入钬激光纤维,在电视监控下将膀胱结石逐个粉碎或击碎,将结石碎成13mm以下, 用Ellik冲洗器反复冲洗将结石清理干净,然后换用电切镜行TURP。    1.3统计学方法采用SPSS 13.0统计学软件。计量资料以均数±标准差(x+_s)表示。计数资料采用卡方检验；两组组间比较采用配对资料的t检验。设P0.05 为差异有统计学意义。    2结果    2.1两组患者围手术期资料比较见表2    由表2可见，与钬激光碎石组比较，开放手术组术中取石时间、住院费用具有明显优势，两组差异均有统计学意义（t 分别2.89、17.87，