高龄前列腺增生患者合并膀胱结石同期处理的治疗评价

目的评价前列腺增生合并膀胱结石同期处理的治疗方法。方法56例患者分为两组,开放手术组采用经耻骨上膀胱小切口取膀胱结石,再行经尿道前列腺电切术(TURP)。气压弹道碎石组先经尿道气压弹道碎石,再行TURP。结果开放手术组患者均一次取石成功,取石时间9～20min,无膀胱出血、膀胱切口渗尿、切口感染等并发症,未出现TURP综合征。术后膀胱冲洗液1、2d转清,造瘘管在5d内拔除,尿管8d内拔除。气压弹道碎石组:改为耻骨上膀胱切开取石术1例,其余患者均一次治疗成功。除碎石时膀胱黏膜有散在充血、水肿外,无1例膀胱穿孔,手术历时50～90min,其中碎石时间10～30min,前列腺手术时间一般控制在60min以内,未发生TURP综合征,未行膀胱造瘘。术后尿液转清时间2、3d,所有患者均于术后48h停止膀胱冲洗,术后5～7d拔除尿管。术中发生尿道损伤率为6.7%,无膀胱损伤穿孔,术后随访3～28个月尿道狭窄发生率为3.3%,采用尿道扩张后治愈。结论开放手术联合TURP、气压弹道碎石联合TURP均可对前列腺增生合并膀胱结石进行同期处理,均为安全有效的方法。

Simultaneous treatment for benign prostate hyperplasia and bladder stone

Objective To study a safe and effective therapy for patients with BPH and bladder stone. Methods Fifty-six cases of BPH and bladder stones were treated by combining transurethral eletroresection with pneumatic lithotripsy (group A), mini-incisions cystolithotomy(group B). Resectoscopy was inserted into bladder by transurethral approach in group B, and oval clamp was inserted through minor incision operation and used to remove the stones under directvision. TURP followed after the removal of stone. Results The procedures were successful in all cases, a follow up of 3 to 28 months found a good outcome in both groups. All the patients had normal micturation after the urethal catheter was withdrawn 5~8 days later, there was no severe complication and no one died. the mean irrigation time, indwelling catheter time and the postoperative hospital stay were more in group A than in group B. Conclusions The results showed that the two therapies of BPH with bladder stones were safe and effective.