前列腺剜除术联合小切口膀胱切开术治疗大体积前列腺增生并膀胱结石的疗效观察

目的:探讨半微创技术即经尿道2μm激光前列腺剜除术联合小切口膀胱切开术,治疗大体积良性前列腺增生(BPH)合并大体积或多发膀胱结石的疗效。方法:对21例大体积BPH合并膀胱结石患者,采用经尿道2μm激光剜除前列腺,后经耻骨上正中切口显露膀胱,将所剜除腺体及结石取出。结果:21例手术均成功,手术时间明显缩短,患者均未输血。术后4~6d拔除尿管。术前与术后6个月Qmax分别为(6.1±2.6)ml/s和(20.5±4.3)ml/s;剩余尿分别为(125.7±61.5)ml与(19.0±5.8)ml;国际前列腺症状评分(IPSS)分别为(21.6±5.2)分与(5.4±3.0)分;生活质量评分(QOL)分别为(4.3±0.5)分与(1.9±0.8)分。四项指标手术前后比较差异均有统计学意义(P0.01)。术后随访3~6个月,2例出现暂时性尿失禁,全部患者无尿瘘、切口感染等手术并发症。结论:经尿道2μm激光前列腺剜除术结合小切口膀胱切开术,一次性治疗大体积BPH合并多发膀胱结石能明显减少手术时间,具有安全、高效的优点,对于大体积BPH合并膀胱多发结石或质硬、直径3cm结石的高龄患者值得推荐应用。

Simultaneous transurethral enucleation of the prostate with small-incision cystolithotomy for patients with large prostate and large vesical calculi

Objective：To investigate the clinical value of 2μm transurethral enucleation and resection of the prostate combined with suprapubic cystolithotomy and prostate removal surgery（half-minimal invasive technique）in the management of patients with large prostate and vesical calculi.Method：All 21 patients with large prostate and large vesical calculi were treated by transurethral enucleation and resection of the prostate with the Revolix 70 W 2micron continuous laser.Then epicystotomy was done to remove enucleated prostate gland and calculi.Result：All operations were successful.Operation time was shorter than traditional therapy.No blood transfusion was needed.Time of indwelling urinary catheter was 4-6days.All patients were followed up for three to six months.No patients had urinary fistula and incision infection.Two patients experienced temporary urinary incontinence.Mean Qmaxincreased from（6.1±2.6）ml/s preoperatively to（20.5±4.3）ml/s six months postoperatively.IPSS and QOL score improved from（21.6±5.2）and（4.3±0.5）to（5.4±3.0）and（1.9±0.8）six months postoperatively respectively（P〈0.05）.Residual urine decreased from（125.7±61.5）ml preoperatively to（19.0±5.8）ml postoperatively.Conclusion：The method of’half-minimal invasive technique’is a rapid,safe and effective procedure in the treatment of BPH with large prostate and vesical calculi.This procedure is also recommended for elderly patients with hard and large（〉3cm）stones.