两种方法治疗高龄高危大体积前列腺增生合并膀胱大结石疗效比较  

Analysis of two different methods for the treatment of high-risk elderly patients with large volume BPH complicated with large bladder calculi

作　　者：刘学森[1] 孙二琳[2] 念学武[1] 李立民[1] 韩瑞发[1,2] 

机构地区：[1]天津医科大学第二医院泌尿外科,天津300211 [2]天津市泌尿外科研究所

出　　处：《临床泌尿外科杂志》2015年第6期521-523,526,共4页Journal of Clinical Urology

摘　　要：目的:探讨高龄高危大体积前列腺增生(BPH)合并膀胱大结石行改良经尿道腔内剜除(M-PKEP)联合膀胱切开取石同期手术治疗的安全性和有效性。方法:将129例高龄高危大体积BPH患者随机分为观察组(M-PKEP联合膀胱切开取石)59例和对照组(TURP联合钬激光碎石)70例。对两组术中及术后相关指标变化值进行比较。结果:129例均顺利完成手术。观察组和对照组手术时间分别为(70.9±8.2)min、(169.9±30)min(P<0.01);术中出血量分别为(78.1±11.5)ml、(159.3±30.6)ml(P<0.01);前列腺切除质量和比例分别为(86.2±18.2)g和(73.2±6.9)%、(67.5±10.6)g和(55.3±7.1)%(P<0.05);术后膀胱持续冲洗时间分别为(45.2±13.2)h、(69.2±16.6)h(P<0.01);术后尿失禁发生比例两组分别为0/59和12/70。术后随访6个月,两组术后IPSS、最大尿流率、剩余尿量较术前均显著改善(P<0.01)。组间比较术后1个月观察组IPSS改善优于对照组(P<0.01),术后6个月剩余尿量改善优于对照组(P<0.01)。所有患者术后6个月复查B超未见结石残留和复发。结论:M-PKEP联合膀胱切开取石手术安全性高,并发症少,疗效显著,适用于高龄高危大体积BPH合并膀胱大结石的治疗,值得临床进一步推广。Objective：To explore the safety and efficacy of modified transurethral plasmakinetic enucleation of the prostate（M-PKEP）combined with small incision of bladder for high-risk elderly patients with large volume benign prostatic hyperplasia（BPH）complicated with large bladder calculi.Method：A total of 129high-risk elderly patients with large volume BPH combined with large bladder calculi were randomly treated with either observer group（M-PKEP combined with small incision of bladder）or control group（standard TURP combined with holmium laser lithotripsy）.Intra-and postoperative clinical data were compared between them.Result：All operations were successfully performed.In observer group and control group,the mean operation time was（70.9±8.2）min and（169.9±30）min（P〈0.01）;intraoperative blood loss was（78.1±11.5）ml,（159.3±30.6）ml（P〈0.01）;resected tissue weight and ratio were（86.2±18.2）g and（73.2±6.9）%,（67.5±10.6）g and（55.3±7.1）%（P〈0.05）,respectively;postoperative bladder irrigation time was（45.2±13.2）h,（69.2±16.6）h（P〈0.01）;the incidence of urinary incontinence was 0/59 and 12/70 respectively.All patients were followed up for six months.IPSS,Qmax,RUV obviously improved postoperatively in all patients compared with the preoperative data,which showed significant differences（P〈0.01）.Better improvements of postoperative one-month IPSS and six-month RUV were found in observer group.No residual stones or recurrence was found.Conclusion：MPKEP combined with small incision of bladder for high-risk elderly patients with large volume BPH complicated with large bladder calculi is efficacy and characterized by fewer complications,and it should be worthy of further clinical application.

关 键 词：前列腺增生 膀胱结石 高危 剜除术 小切口 

分 类 号：R697.3[医药卫生—泌尿科学] R694.4[医药卫生—外科学]