目的：探讨经尿道前列腺双极等离子电切术（ transurethral plasmakinetic resection of the prostate ，TUPKRP）联合经皮膀胱穿刺造瘘钬激光碎石术治疗高龄高危良性前列腺增生（ benign prostate hyperplasia ， BPH ）合并膀胱结石的效果。方法回顾性分析2009年1月～2014年5月采用该方法治疗BPH合并膀胱结石73例患者的临床资料，年龄70～95岁，平均85．6岁，均伴有1种或以上心脑血管等并发症，术前B超测量前列腺35～105 g，其中58例提示中叶明显突入膀胱，膀胱结石直径1．5～4．5 cm。结果73例均一次手术成功，碎石时间15～50 min，平均24 min；前列腺电切时间40～135 min，平均70 min。术中术后无大出血、电切综合征、膀胱穿孔、结石残留、严重感染等并发症发生。术后3～5天拔除尿管，无尿漏、排尿困难、尿失禁，病理检查均为BPH。术后住院时间5～10 d，平均6 d。术后3个月国际前列腺症状评分（IPSS）由（23．5±5．1）分降至（7．5±1．6）分，生活质量评分（QOL）由（5．1±0．5）分降至（2．2±0．8）分，最大尿流率（Qmax）由（6．2±2．4）ml／s上升至（17．9±4．2）ml／s，残余尿量由（185．6±29．7）ml降至（30．0±21．2）ml（P均＜0．05）。结论 TUPKRP联合经皮膀胱穿刺造瘘钬激光碎激光碎石术是治疗高龄高危BPH合并膀胱结石的安全有效的方法。%Objective To evaluated the role of transurethral plasmakinetic resection of the prostate ( TUPKRP ) in combination with percutaneous bladder channel lithotripsy with holmium laser in the treatment of benign prostate hyperplasia ( BPH) and bladder stone in senior patients . Methods Seventy-three patients treated during January 2009 to May 2014 were retrospectively reviewed.The patients aged 70-95 years old (mean, 85.6 years old).All of the patients were complicated with one or more diseases of the cardiovascular system .Ultrasound examinations prior to operation showed the sizes of prostates ranging 35-105 g, among which 58 cases showed middle prostatic lobe protruding into the bladder cavity .The sizes of the bladder stones ranged 1.5 -4.5 cm. Results The operations were successful in all the cases .The time of lithotripsy ranged 15-50 min (mean, 24 min), and the time of prostatectomy ranged 40 -135 min (mean, 70 min).No severe complications, such as major bleeding, transurethral resection syndrome, bladder perforation, residual stones, or severe infections, were observed.The urethral catheters were removed 3-5 days after operation, without urine leakage, dysuria, or urinary incontinence.Post-operation pathology of all the cases revealed BPH .The duration of hospitalization was 5-10 d (mean, 6 d).Three months after operation, the international prostate symptom scores were decreased from (23.5 ±5.1) points to (7.5 ±1.6) points (P<0.05), the quality of life (QOL) scores were decreased from (5.1 ± 0.5) points to (2.2 ±0.8) poins (P<0.05), the maximum flow rates (Qmax) were increased from (6.2 ±2.4) ml/s to (17.9 ± 4.2) ml/s (P<0.05), and residual urine volumes were decreased from (185.6 ±29.7) ml to (30.0 ±21.2) ml (P<0.05). Conclusion Transurethral plasmakinetic resection of the prostate in combination with percutaneous bladder channel lithotripsy with holmium laser is safe and effective for the treatment of benign prostate hyperplasia and bladder stone in senior patients .
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