经尿道前列腺电切术联合气压弹道碎石治疗前列腺增生合并膀胱结石的中长期随访报告  

Transurethral Resection of Prostate Combined With Pneumatic Ballistic Lithotripsy in the Treatment of Benign Prostatic Hyperplasia Complicated With Bladder Calculi:a Medium and Long-term Follow-up Report

作　　者：邱智[1] 吴栗洋 王伟[1] 王飚[1] 乔鹏[1] 张军晖[1] 王建文[1] 张小东[1] Qiu Zhi;Wu Liyang;Wang Wei(Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《中国微创外科杂志》2019年第5期385-387,393,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨一期腔内治疗前列腺增生(benign prostatic hyperplasia,BPH)合并膀胱结石的中长期随访结果。方法 2007年3月～2018年10月我们对88例BPH合并膀胱结石,采用经电切镜外鞘置入肾镜,气压弹道将膀胱结石击碎,利用高压水流和Ellik冲洗器吸净结石后,同期行经尿道前列腺切除术(transurethral resection of prostate,TURP)。结果 87例(98. 9%)一次手术成功,无中转开放手术,无输血、经尿道前列腺电切综合征(transurethral resection syndrome,TURS)及严重感染等并发症发生。1例因碎石导致膀胱穿孔,取净结石后保留尿管,二期行TURP。77例术后6个月复查,无尿失禁、尿道狭窄等并发症,KUB未见结石复发;与术前比较,术后6个月国际前列腺症状评分(International Prostatic Syndrome Score,IPSS)[(6. 5±3. 8)分vs.(24. 6±5. 5)分,t=26. 827,P=0. 000],Qmax[17(3～40) ml/s vs. 4(1～20) ml/s,Z=-7. 543,P=0. 000],残余尿量[0(0～150) ml vs. 127(0～512) ml,Z=-7. 274,P=0. 000]差异均有显著性。77例中位随访时间68个月(6～120个月),8例(10. 4%)膀胱结石复发:随访<3年11例中,1例(9. 1%)复发,因尿道狭窄行膀胱结石气压弹道碎石+定期尿道扩张后治愈;随访3～5年14例中,2例(14. 3%)复发,因高龄导致膀胱逼尿肌老化,行膀胱造瘘+膀胱结石气压弹道碎石;随访> 5年52例中,5例(9. 6%)复发,其中3例因膀胱逼尿肌老化,行膀胱造瘘+膀胱结石气压弹道碎石,2例因BPH再次行TURP联合膀胱结石气压弹道碎石治愈。结论 TURP联合经电切镜外鞘肾镜下气压弹道碎石治疗BPH合并膀胱结石创伤小,安全高效,中长期随访效果满意。Objective To investigate the medium and long-term effectiveness of endourological treatment of benign prostatic hyperplasia (BPH) complicated with bladder stone at one session.Methods From March 2007 to October 2018,88 patients with BPH complicated with bladder stones were treated by pneumatic ballistic lithotripsy under nephroscope via outer sheath of resectoscope.After the calculi were removed by high-pressure water flow and Ellik irrigator,the transurethral resection of prostate(TURP) was performed simultaneously.Results A total of 87 cases (98.9%) were successfully operated with endourological treatment simultaneously.No conversion to open surgery was needed.No blood transfusion,transurethral resection syndrome or severe infection occurred.One case had bladder perforation due to lithotripsy,and a urinary catheter was retained after removing the stones until a secondary TURP.Follow-ups at 6 months after surgery in the 77 patients showed there was no urinary incontinence or urethral stricture,or recurrence of stones under KUB.As compared with preoperation,there were significant differences 6 months after surgery in the International Prostatic Syndrome Score [(6.5±3.8) points vs.(24.6±5.5) points,t =26.827,P =0.000],maximum urinary flow rate [17(3- 40) ml/s vs.4 (1-20) ml/s,Z =-7.543,P =0.000],and residual urine volume [0 (0-150) m1 vs.127 (0- 512) ml,Z =-7.274,P =0.000].The median follow-ups duration in the 77 patients was 68 months(range,6-120 months).There were 8 cases (10.4%) of recurrence of stones.Of the 11 cases followed up for less than 3 years,1 case (9.1%) recurred and was cured by pneumatic ballistic lithotripsy with regular urethral dilatation.Of the 14 cases followed up for 3-5 years,2 cases (14.3%) recurred,due to bladder detrusor aging in the elderly patients,bladder cystostomy with pneumatic ballistic lithotripsy was performed for bladder calculi.Of the 52 cases followed up for more than 5 years,5 cases (9.6%) recurred,3 of which underwent bladder cystostomy with pneumatic ballistic lithotripsy

关 键 词：前列腺增生 膀胱结石 经尿道前列腺电切术 气压弹道碎石 

分 类 号：R699[医药卫生—泌尿科学]