經皮膀胱造瘺輸尿管鏡鈥激光碎石聯合TURP在BPH合并膀胱結石中的應用

何靖 王海洋 肖嘉伍

摘要：目的? 探討經皮膀胱造瘺輸尿管鏡鈥激光碎石術聯合經尿道前列腺電切術（TURP）治療前列腺增生（BPH）合并膀胱結石的有效性及安全性。方法? 回顧性分析2016年8月～2018年8月重慶大學附屬三峽醫院泌尿外科收治的80例BPH合并膀胱結石患者的臨床資料，依據手術方式不同分為對照組42例和觀察組38例。對照組行經尿道輸尿管鏡鈥激光碎石術聯合TURP，觀察組行經皮膀胱造瘺輸尿管鏡鈥激光碎石術聯合TURP，比較兩組一次清石率、碎石時間、手術時間、術中失血量、并發癥、術后3個月國際前列腺癥狀評分（IPSS）、最大尿流率（Qmax）及殘余尿量（PVR）。結果? 觀察組一次清石率為100.00%，高于對照組的85.71%，差異有統計學意義（P<0.05）。觀察組碎石時間、手術時間、術中失血量分別為（35.91±4.80）min、（134.03±13.46）min、（95.84±14.56）ml，均少于對照組的（48.64±8.52）min、（155.46±17.33）min、（106.52±18.90）ml，差異有統計學意義（P<0.05）。觀察組并發癥發生率為10.53%，與對照組的16.67%比較，差異無統計學意義（P>0.05）。術后3個月，觀察組IPSS評分、Qmax及PVR分別為（4.57±0.75）分、（18.47±4.62）ml/s、（32.56±20.25）ml，與對照組的（4.74±0.83）分、（17.96±5.41）ml/s、（30.24±18.78）ml比較，差異無統計學意義（P>0.05）。結論? 經皮膀胱穿刺造瘺輸尿管鏡鈥激光碎石術聯合TURP具有清石率高、碎石時間及手術時間短、術中失血量少等優點，是一種安全有效的手術方式。

關鍵詞：經皮膀胱造瘺輸尿管鏡鈥激光碎石術;經尿道前列腺等離子電切術;良性前列腺增生;膀胱結石

Abstract：Objective? To investigate the effectiveness and safety of percutaneous cystostomy and ureteroscopic holmium laser lithotripsy combined with transurethral resection of the prostate （TURP） in the treatment of benign prostatic hyperplasia （BPH） with bladder stones.Methods? A retrospective analysis of the clinical data of 80 patients with BPH and bladder stones admitted to the Department of Urology，Three Gorges Hospital of Chongqing University from August 2016 to August 2018， was divided into 42 cases in the control group and 38 cases in the observation group according to different surgical methods. The control group underwent transurethral ureteroscopic holmium laser lithotripsy combined with TURP， and the observation group underwent percutaneous cystostomy and ureteroscopy holmium laser lithotripsy combined with TURP. The two groups were compared with one stone removal rate， lithotripsy time， operation time， and intraoperative blood loss complications， International Prostate Symptom Score （IPSS）， Maximum Urine Flow Rate （Qmax） and Residual Urine Volume （PVR） 3 months after operation.Results? The rate of one-time stone removal in the observation group was 100.00%， which was higher than 85.71% in the control group，the difference was statistically significant （P<0.05）. The lithotripsy time， operation time， and intraoperative blood loss in the observation group were （35.91±4.80） min， （134.03±13.46） min， and （95.84±14.56） ml， respectively， which were less than those in the control group （48.64±8.52） min and （ 155.46±17.33） min， （106.52±18.90） ml， the difference was statistically significant （P<0.05）. The complication rate in the observation group was 10.53%， which was not statistically significant compared with 16.67% in the control group （P>0.05）. Three months after surgery， the IPSS score， Qmax and PVR of the observation group were （4.57±0.75） points， （18.47±4.62） ml/s， （32.56±20.25） ml， respectively， compared with those of the control group （4.74±0.83） points， （17.96±5.41） ml/s and （30.24±18.78） ml， the difference was not statistically significant （P>0.05）.Conclusion? Percutaneous cystostomy and ureteroscopic holmium laser lithotripsy combined with TURP have the advantages of high stone removal rate， short lithotripsy time and operation time， and less blood loss during the operation. It is a safe and effective operation method.