良性前列腺增生症合并膀胱结石27例的治疗

目的探讨良性前列腺增生症(BPH)并膀胱结石的有效治疗方法。方法 27例BPH合并膀胱结石患者分别采用经尿道前列腺电切术(TURP)结合电切环结石勾出和(或)冲出(A组,7例)、经尿道前列腺电切术结合体外冲击波碎石术(ESWL)(B组,6例)、耻骨上膀胱切开取石术+前列腺增生部摘除术(C组,14例)治疗。结果 27例均手术成功,除1例开放手术后膀胱裂开,二次缝合改置膀胱造瘘管出院后因其他原因死亡外,术后拔管后均排尿正常。A组和B组术后膀胱冲洗时间、留置尿管时间及住院时间明显少于C组。A组和B组无明显手术并发症,而C组中3例出现并发症,分别是脑梗死、继发大出血、切口裂开。结论良性前列腺增生症合并膀胱结石的治疗有多种安全、有效的方法,可根据具体情况选择合适的手术方式。采用TURP结合ESWL创伤小,术后恢复快,住院时间短,达到现代外科的微创治疗目的。而开放手术在前列腺较大、结石较大或为多发情况下采用仍不失为基层医院的一种好办法,但要尽量避免术中、术后并发症的发生。

Treatment of benign prostatic hyperplasia with bladder calculus in 27 cases

Objective To investigate the effective treatments of benign prostatic hyperplasia（BPH） with bladder calculus.Methods We employ transurethral resection of prostate（TURP） combined with electric loop to pull or wash calculus（group A）,transurethral resection of prostate with extracorporeal shock wave lithotripsy（ESWL）（group B）,suprapubic lithotomy of bladder combined with suprapubic prostatectomy（group C）,respectively,to treat benign prostatic hyperplasia with bladder calculus in 27 cases.Results The outcome were that 27 patients,operation were successful with the normal voiding after extubation,excluding a case of post-operated rupture of bladder treated with fistula that died of other cause after hospitalization.Time of flushing bladder,indwelling catheter and hospitalization in group A and group B were shorter significantly compared with group C.There was no significant postoperative complication in group A or group B,and the emergence of complications in 3 patients were in group C,including cerebral infarction,secondary hemorrhage and wound dehiscence.Conclusion There are many safe and effective treatments for benign prostatic hyperplasia with bladder calculus,appropriate operative treatments are choosed according to actuality.We have achieved minimally invasive and contemporary therapeutic purpose,because TURP combined with ESWL expressing less trauma,faster postoperative recovery,and shorter hospitalization.And open prostate surgery is still a good therapeutic method especially in a primary hospital when there are large prostate,large or multiple calculus.However we need minimize the risks of intraoperative and postoperative complications.