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外科研究与新技术（中英文）

外科研究与新技术 ›› 2023, Vol. 12 ›› Issue (1): 36-39.doi: 10.3969/j.issn.2095-378X.2023.01.010

• 论著 • 上一篇    下一篇

经尿道腔内同期微创手术治疗良性前列腺增生症合并膀胱结石的临床观察

刘吉平, 张国胜, 单小辉, 刘啸雨   

  1. 秦皇岛市抚宁区人民医院泌尿外科,河北 秦皇岛 066300
  • 收稿日期:2022-04-25 发布日期:2023-05-26
  • 作者简介:刘吉平（1974—）,男,大学本科,主任医师,从事临床泌尿外科工作;电子信箱：tiger120007@sina.com

Clinical observation of simultaneous transurethral intracavitary and minimally invasive surgery for benign prostatic hyperplasia combined with bladder stones

LIU Jiping, ZHANG Guosheng, SHAN Xiaohui, LIU Xiaoyu   

  1. Department of Urology, Funing People's Hospital of Qinhuangdao, Qinhuangdao 066300, Hebei, China
  • Received:2022-04-25 Published:2023-05-26

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摘要： 目的 探讨良性前列腺增生（BPH）合并膀胱结石经尿道腔内同期微创手术治疗的临床效果。方法 选取2016年1月—2021年7月抚宁区人民医院收治前列腺增生合并膀胱结石患者130例,随机分为观察组和对照组,每组65例。观察组行经尿道膀胱结石气压弹道碎石术（transurethral barometric trajectory lithotomy,TUBTL）或经尿道膀胱结石钬激光碎石术（transurethral holmium laser lithotripsy, TUHLL）,同期经尿道前列腺等离子双极电切术（plasmakinetic resection of prostate, PKRP）,对照组行TUBTL或TUHLL。观察对两组患者的各项手术指标,对两组患者手术前、后以及组间的症状改善情况进行对比分析。结果 130例患者均手术成功。膀胱结石碎石手术时间8~35 min,平均（17±5.6） min[其中钬激光碎石时间8~20 min,平均（14±3.2） min;气压弹道碎石时间10~35 min,平均（18±6.2） min],术后住院时间5~8 d,平均（6.9±0.6） d。观察组前列腺电切手术时间26~125 min,平均（65±28.2） min,术中出血60~350 mL,平均（110±54.5） mL。两组患者术前IPSS、Qmax、RU无显著差异（P>0.05）;观察组术后的IPSS、Qmax、RU较术前明显改善,差异有统计学意义（P<0.05）;观察组患者术后IPSS、Qmax、RU改善效果较对照组更优,差异有统计学意义（P<0.05）。观察组术后复查腹部X线平片（KUB）未见结石复发,无尿失禁、血尿等并发症。结论 BPH合并膀胱结石采取TUBTL或TUHLL,同期行PKRP,具有安全高效,并发症少,明显改善患者症状提高临床疗效,值得推广应用。

关键词: 良性前列腺增生症, 膀胱结石, 经尿道前列腺等离子双极电切术, 气压弹道碎石术, 钬激光碎石术

Abstract: Objective To investigate the clinical outcomes of simultaneous transurethral intracavitary and minimally invasive surgery for benign prostatic hyperplasia (BPH) with bladder stones. Methods A total of 130 patients with BPH and bladder stones admitted to Funing People's Hospital from January 2016 to July 2021 were selected and randomly divided into an observation group and a control group, with 65 cases in each group. In the observation group, transurethral barometric trajectory lithotomy (TUBTL) or transurethral holmium laser lithotripsy (TUHLL) was performed, and transurethral plasmakinetic resection of prostate (PKRP) was performed at the same time. In the control group, only TUBTL or TUHLL was performed. The patients in the two groups were compared in surgery-related indicators and the improvement of symptoms before and after surgery. Results All operations were successful. The lithotomy time was 8-35 min, (17±5.6) min in average. Specifically, the time was 8-20 (14±3.2) min for TUHLL and 10-35 (18±6.2) min for TUBTL. The postoperative hospital stay was 5-8 (6.9±0.6) d. In the observation group, the operation time for PKRP was 26-125 (65±28.2) min, and the blood loss amount was 60-350 (110±54.5) mL. Preoperaitve IPSS, Qmax, and RU were not significantly different between the two groups (P>0.05). The postoperative IPSS, Qmax, and RU in the observation group were significantly better than the preoperative indicators in the same group and the postoperative indicators in the control group (P<0.05). In the observation group, no recurrence of stones was seen on postoperative kidney/ureter/bladder (KUB) radiographs, and there were no complications such as urinary incontinence and haematuria. Conclusion The use of TUBTL/TUHLL and PKRP at the same time is safe and efficient in the treatment of BPH and bladder stones, with few complications, and significantly improves patients' symptoms, deserving wide application.

Key words: Benign prostatic hyperplasia, Bladder stones, Transurethral plasma kinetic resection of prostate, Barometric trajectory lithotomy, Holmium laser lithotripsy

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