【摘要】 目的探讨经皮膀胱造瘘钬激光碎石术联合经尿道前列腺等离子电切术(PKRP)治疗良性前列腺增生(BPH)合并膀胱结石的疗效。方法回顾性分析98例BPH合并膀胱结石患者的临床资料,根据治疗方法将患者分为A组(经尿道膀胱钬激光碎石术联合PKRP治疗)62例与B组(经皮膀胱造瘘钬激光碎石术联合PKRP治疗)36例。比较两组患者手术总时间、碎石时间、前列腺电切时间、术后住院时间、术后6 h疼痛视觉模拟量表(VAS)评分、镇痛药使用率,以及手术前后的国际前列腺症状评分法(IPSS)评分、生活质量量表(QOL)评分和患者满意度等指标。结果两组患者的手术总时间、膀胱冲洗时间、拔除尿管时间、术后住院时间、并发症发生率、住院满意度及术后血红蛋白水平、白细胞计数、血清钠水平比较,差异均无统计学意义(均P>0.05),而B组患者碎石时间长于A组,前列腺电切时间短于A组,术后6 h的疼痛VAS评分及镇痛药物使用率高于A组(均P<0.05)。两组患者术后的IPSS和QOL评分均低于术前(均P<0.05),但两组术后的IPSS和QOL评分比较,差异无统计学意义(均P>0.05)。结论经皮膀胱造瘘钬激光碎石术联合PKRP治疗BPH合并膀胱结石患者的疗效确切,与经尿道膀胱钬激光碎石术联合PKRP一样,可明显改善患者的下尿路症状及生活质量,与后者相比,前列腺电切手术时间更短,尤其适用于大体积BPH合并膀胱结石患者,但术后早期疼痛增加。更多还原

【Abstract】 Objective To investigate the efficacy of percutaneous cystostomy and holmium laser lithotripsy combined with transurethral plasmakinetic resection of prostate(PKRP) for the treatment of benign prostatic hyperplasia(BPH) complicated with bladder stone. Methods The clinical data of 98 patients with BPH complicated with bladder stone were retrospectively analyzed. According to the treatment methods, they were divided into group A(62 cases receiving transurethral holmium laser lithotripsy combined with PKRP treatment) and group B(36 cases receiving percutaneous cystostomy and holmium laser lithotripsy combined with PKRP treatment). The relevant indices were compared between the two groups, including overall operation duration, duration of lithotripsy, duration of plasmakinetic prostatectomy, postoperative hospitalization time, postoperative 6-hour Visual Analogue Scale(VAS) pain score, rate of analgesics use, as well as the International Prostate Symptom Score(IPSS) and Quality of Life Scale(QOL) scores, and patient satisfaction before and after operation. Results There was no statistically significant difference between the two groups in overall operation time, bladder flushing time, time of catheter removal, postoperative hospitalization time, incidence rate of complications, satisfaction with hospitalization, postoperative hemoglobin level, WBC count, or serum sodium level(all P>0.05), whereas group B exhibited increased duration of lithotripsy, shorter duration of plasmakinetic prostatectomy, higher VAS pain score and increased analgesics use rate six hours after operation as compared with group A(all P<0.05). In both groups, postoperative IPSS and QOL scores were lower than the preoperative(all P<0.05), but there was no statistically significant difference in postoperative IPSS or QOL scores between the two groups(all P>0.05).Conclusion Percutaneous cystostomy and holmium laser lithotripsy combined with PKRP has a definite efficacy for BPH patients complicated with bladder stone. It can notably improve patients′ lower urinary tract symptoms and quality of life as transurethral holmium laser lithotripsy combined with PKRP, and yields shorter duration of plasmakinetic prostatectomy over the latter procedure, especially for large BPH patients complicated with bladder stone, but might increase early pain postoperatively.更多还原