等离子电切镜联合输尿管镜下钬激光碎石与前列腺等离子切除术治疗前列腺增生合并膀胱结石33例

摘要

To discuss the therapeutic effect of plasma kinetic vaporization combined with ureteroscopic holmium laser lithotripsy and transurethral plasmakinetic resection of prostate ( PKRP) for the treatment of benign prostatic hyperplasia ( BPH) complicated with urinary bladder calculi. Methods Under continuous epidural anesthesia, Wolf F8.0/9.8 hardness ureteroscope was placed inserted through the extema of a resectoscope with water inflowing via the ureteroscopic prosopyle, and outflowing through the resectoscopic epitheca. By moving the epitheca of the ion resectoscope, we identified the urinary bladder calculi, and performed holmium laser lithotripsy by ureteroscopy. The fragmented calculi were then washed out with Ellik flusher. Afterwards, we inserted plasma kinetic vaporizer for PKRP, and F22 three cavity balloon catheter after fragmented tissues were flushed out. Results The procedure was successfully completed in all the patients in one session, without causing severe complications. Postoperative KUB showed no residual stones, and the stone clearance rate was 100% . After the operation, IPSS score of the patients decreased from 29 ± 4 preoperatively to 9 ± 3 (t = 4. 595 , P = 0.000) , QOL decreased from 4. 5 ± 2. 1 to 2. 5 ± 1. 0 ( t = 4. 954, P = 0. 000 ) , and the Qmax increased from (5.7 ±3.1) ml/sto (18.0±6.0) ml/s (t = 8. 913 , P = 0. 000 ) . Conclusions Plasma kinetic vaporization combined with ureteroscopic holmium laser lithotripsy and transurethral PKRP is effective, safe, minimally invasive for BPH complicated with urinary bladder calculi, with few complications and quick recovery.%目的 探讨等离子电切镜联合输尿管镜下钬激光碎石与前列腺等离子切除术( transurethral plasmakinetic resection of prostate,PKRP)治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)合并膀胱结石的疗效. 方法 连续硬膜外麻醉后,通过电切镜外鞘置入Wolf F8.0/98硬性输尿管镜,由输尿管镜镜鞘的进水孔进水,电切镜外鞘出水.活动离子电切镜外鞘寻找膀胱结石,找到膀胱结石后,通过输尿管镜操作通道置入钬激光碎石逐渐将结石碎成小块,Ellik冲洗器将已破碎的结石冲出膀胱外.然后置入等离子电切镜操作件,行前列腺等离子切除术( plasmakinetic resection of prostate,PKRP).术毕,Elick冲洗器冲洗清除组织碎块,留置F22三腔气囊尿管接冲洗. 结果 33例均一次治疗成功,无严重并发症发生.术后复查KUB,均无结石残留,清石率达100％.国际前列腺症状评分(IPSS) (9±3)分,显著低于术前(29±4)分(t=4.595,P=0.000);生活质量评分(QOL)(2.5±1.0)分,显著低于术前(4.5±2.1)分(t=4.954,P=0.000);最大尿流率(Qmax) (18.0±6.0) ml/s,显著高于术前(5.7±3.1)ml/s(t =8.913,P=0.000).33例术后随访1～ 24个月,平均12个月,未出现尿道狭窄等远期并发症,均无结石复发. 结论 等离子电切镜外鞘输尿管镜下钬激光碎石联合经尿道PKRP治疗BPH合并膀胱结石,具有创伤小、恢复快、安全高效、并发症少的优点.