经皮膀胱造瘘输尿管镜钬激光碎石联合TURP在BPH合并膀胱结石中的应用

何靖 王海洋 肖嘉伍

摘要：目的  探討经皮膀胱造瘘输尿管镜钬激光碎石术联合经尿道前列腺电切术（TURP）治疗前列腺增生（BPH）合并膀胱结石的有效性及安全性。方法  回顾性分析2016年8月～2018年8月重庆大学附属三峡医院泌尿外科收治的80例BPH合并膀胱结石患者的临床资料，依据手术方式不同分为对照组42例和观察组38例。对照组行经尿道输尿管镜钬激光碎石术联合TURP，观察组行经皮膀胱造瘘输尿管镜钬激光碎石术联合TURP，比较两组一次清石率、碎石时间、手术时间、术中失血量、并发症、术后3个月国际前列腺症状评分（IPSS）、最大尿流率（Qmax）及残余尿量（PVR）。结果  观察组一次清石率为100.00%，高于对照组的85.71%，差异有统计学意义（P<0.05）。观察组碎石时间、手术时间、术中失血量分别为（35.91±4.80）min、（134.03±13.46）min、（95.84±14.56）ml，均少于对照组的（48.64±8.52）min、（155.46±17.33）min、（106.52±18.90）ml，差异有统计学意义（P<0.05）。观察组并发症发生率为10.53%，与对照组的16.67%比较，差异无统计学意义（P>0.05）。术后3个月，观察组IPSS评分、Qmax及PVR分别为（4.57±0.75）分、（18.47±4.62）ml/s、（32.56±20.25）ml，与对照组的（4.74±0.83）分、（17.96±5.41）ml/s、（30.24±18.78）ml比较，差异无统计学意义（P>0.05）。结论  经皮膀胱穿刺造瘘输尿管镜钬激光碎石术联合TURP具有清石率高、碎石时间及手术时间短、术中失血量少等优点，是一种安全有效的手术方式。

关键词：经皮膀胱造瘘输尿管镜钬激光碎石术;经尿道前列腺等离子电切术;良性前列腺增生;膀胱结石

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.