經尿道碎石術和經尿道前列腺電切術治療良性前列腺增生伴膀胱結石_《華西醫學》

作者：

王安果 , 張宗平 , 李云祥

川北醫學院第二臨床學院泌尿外科（四川南充，637000）;

關鍵詞：

良性前列腺增生膀胱結石碎石術經尿道前列腺電切術

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【摘要】　目的　探討良性前列腺增生（benign prostatic hyperplasia，BPH）伴膀胱結石的有效腔內治療方法。〖HTH〗方法　2003年6月-2009年12月，使用F26號電切鏡外鞘作為撐開器，氣壓彈道和（或）鈥激光粉碎膀胱結石，經尿道前列腺電切術（transurethral resection of the prostate，TURP）治療BPH伴膀胱結石86例。患者年齡58～83歲，平均68.6歲；病程2～8年，平均5.2年。術前患者國際前列腺癥狀評分（international prostate symptom score，IPSS）為（24.6±3.9）分，生活質量（5.7±0.6）分；前列腺重量（46.5±6.8） g，剩余尿量（185±58） mL，最大尿流率（5.7±2.3） mL/s。　結果　 86例均一次手術成功。碎石時間為16~58 min，平均38 min；前列腺電切時間40~100 min，平均65 min。術中無并發癥發生。術后 5~8 d拔除尿管，平均6.5 d。術后4 例出現前尿道狹窄，經治療后痊愈。54例獲隨訪，隨訪時間2~6個月，平均3個月。術后2個月，54例最大尿流率升至（18.5±4.1） mL/s，剩余尿量下降至（16±22） mL，IPSS評分下降至（7.8±1.6）分，生活質量（2.5±0.3）分，與術前比較差異均有統計學意義（P lt;0.01）。　結論　經尿道碎石術和TURP一次性治療BPH伴膀胱結石安全、有效、經濟。
【Abstract】　Objective　 To explore an effective endourologic treatment method for benign prostatic hyperplasia (BPH) with bladder calculi. 　Methods　 From June 2003 to December 2009, ballistic or holmium laser lithotripsy by outer sheath resectoscope and transurethral resection of the prostate (TURP) were performed on 86 patients with BPH and bladder calculi. The patients aged 58 to 83 years old, averaging at 68.6 years. Duration of their disease course ranged from 2 to 8 years, averaging 5.2 years. Before surgery, the international prostate symptom score (IPSS) was 24.6±3.9; the score of quality of life (QOL) was 5.7±0.6; prostatic weight was (46.5±6.8) g; residual urine (RU) volume was (185±58) mL; and the peak urine flow rate (Qmax) was (5.7±2.3) mL/s.　Results　 The operations were completed successfully in all cases with a mean lithotripsy time of 38 min (16-58 minutes) and a mean TURP time of 65 min (40-100 minutes). No complications occurred during the operation. Urethral catheter was withdrawn 5-8 days after operation, with a mean period of 6.5 days. Four patients had anterior urethral stricture after operation, but recovered through treatment. Fifty-four patients were followed up for 2 to 6 months with an average follow-up time of 3 months. Two months after the operations, IPSS decreased to 7.8±1.6; Qmax increased to (18.5±4.1) mL/s; RU decreased to (16±22) mL and QOL was 2.5±0.3. Compared with preoperative conditions, the differences were all statistically significant (P＜0. 01).　Conclusion　 Transurethral lithotripsy combined with TURP is an effective, safe and economical treatment for benign prostatic hyperplasia with bladder calculi.

引用本文： 王安果,張宗平,李云祥. 經尿道碎石術和經尿道前列腺電切術治療良性前列腺增生伴膀胱結石. 華西醫學, 2011, 26(9): 1345-1347. doi: 復制

1.	Papatsoris AG, Varkarakis I, Dellis A, et al. Bladder lithiasis: from open surgery to lithotripsy[J]. Urol Res, 2006, 34(3): 163-167.
2.	候巖松, 蔣振華, 俞增福, 等. 前列腺增生癥合并膀胱結石的微創手術治療[J]. 中國內鏡雜志, 2009, 15(2): 188-189.
3.	桂澤紅, 張策, 王樹聲, 等. 兩種方法治療前列腺增生癥合并膀胱結石的比較[J]. 實用醫學雜志, 2005, 21(4): 389-390.
4.	李頌, 郅焱, 施國強, 等. 前列腺增生癥伴膀胱結石腔內治療體會(附16例報告)[J]. 國際醫藥衛生導報, 2007, 13(8): 27-29.
5.	張軍暉, 邢念增, 李建興, 等. TURP 聯合腎鏡下彈道超聲波碎石清石術治療前列腺增生并發膀胱結石(附43例報告)[J]. 臨床泌尿外科雜志, 2008, 23(2): 109-110.
6.	Shah HN, Hegde SS, Shah JN, et al. Simultaneous transurethral cystolithotripsy with holmiumlaser enucleation of the prostate: a prospective feasibility study and review of literature[J]. BJU Int, 2007, 99(3): 595-600.
7.	Tugcu V, Polat H, Ozbay B, et al. Percutaneous versus transurethral cystolithotripsy[J]. J Endourol, 2009, 23(2): 237-241.
8.	盧劍, 肖春雷, 馬潞林, 等. 經電切鏡外鞘氣壓彈道治療膀胱結石20 例報道[J].中國微創外科雜志, 2006, 5(3): 221-222.
9.	Chtourou M, Ben Younes A, Binous MY, et al. Combination of ballistic lithotripsy andtransurethral prostatectomy bladder stones with benign prostatic hyperplasia: report of 120 cases[J]. J Endourol, 2001, 15(8): 851-853.
10.	龔雋, 葛京平, 周水根, 等. 三種膀胱結石治療方法的臨床比較[J]. 臨床泌尿外科雜志, 2010, 25(1): 8-10.

1. 　Papatsoris AG, Varkarakis I, Dellis A, et al. Bladder lithiasis: from open surgery to lithotripsy[J]. Urol Res, 2006, 34(3): 163-167.
2. 　候巖松, 蔣振華, 俞增福, 等. 前列腺增生癥合并膀胱結石的微創手術治療[J]. 中國內鏡雜志, 2009, 15(2): 188-189.
3. 　桂澤紅, 張策, 王樹聲, 等. 兩種方法治療前列腺增生癥合并膀胱結石的比較[J]. 實用醫學雜志, 2005, 21(4): 389-390.
4. 　李頌, 郅焱, 施國強, 等. 前列腺增生癥伴膀胱結石腔內治療體會(附16例報告)[J]. 國際醫藥衛生導報, 2007, 13(8): 27-29.
5. 　張軍暉, 邢念增, 李建興, 等. TURP 聯合腎鏡下彈道超聲波碎石清石術治療前列腺增生并發膀胱結石(附43例報告)[J]. 臨床泌尿外科雜志, 2008, 23(2): 109-110.
6. 　Shah HN, Hegde SS, Shah JN, et al. Simultaneous transurethral cystolithotripsy with holmiumlaser enucleation of the prostate: a prospective feasibility study and review of literature[J]. BJU Int, 2007, 99(3): 595-600.
7. 　Tugcu V, Polat H, Ozbay B, et al. Percutaneous versus transurethral cystolithotripsy[J]. J Endourol, 2009, 23(2): 237-241.
8. 　盧劍, 肖春雷, 馬潞林, 等. 經電切鏡外鞘氣壓彈道治療膀胱結石20 例報道[J].中國微創外科雜志, 2006, 5(3): 221-222.
9. 　Chtourou M, Ben Younes A, Binous MY, et al. Combination of ballistic lithotripsy andtransurethral prostatectomy bladder stones with benign prostatic hyperplasia: report of 120 cases[J]. J Endourol, 2001, 15(8): 851-853.
10. 　龔雋, 葛京平, 周水根, 等. 三種膀胱結石治療方法的臨床比較[J]. 臨床泌尿外科雜志, 2010, 25(1): 8-10.

《華西醫學》

經尿道碎石術和經尿道前列腺電切術治療良性前列腺增生伴膀胱結石

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《華西醫學》

經尿道碎石術和經尿道前列腺電切術治療良性前列腺增生伴膀胱結石

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