摘要：
目的 探讨BPH并膀胱结石一期腔内治疗的有效方法.方法 回顾分析经尿道钬激光碎石及双导管碎石联合经尿道等离子体双极汽化前列腺电切术治疗BPH并膀胱结石32例患者的临床资料.结果 32例患者(钬激光碎石26例,双导管碎石6例),其中30例(93.75%)一期腔内手术成功,另2例(6.25%)因膀胱结石巨大,质地较硬,钬激光碎石时间长,膀胱黏膜充血水肿明显,先行前列腺等离子体电切后,然后行小切口取出膀胱结石.碎石时间10~50 min,平均24 min;前列腺电切术时间35~110 min,平均65 min;术中出血80~200 ml,平均120 ml.术中无膀胱穿孔及电切综合征发生.术后拔除尿管,无排尿困难、尿失禁及结石残留.术后6个月复查,无尿道狭窄及膀胱结石复发,国际前列腺症状评分(IPSS),最大尿流率(Qmax),生活质量评分(QOL)均较术前有显著性改善.结论 经尿道钬激光碎石及双导管碎石联合经尿道等离子体双极汽化前列腺电切术治疗BPH并膀胱结石,创伤小,恢复快,安全有效,尤其双导管碎石能快速高效地清除较大的膀胱结石,是较理想的手术方法.%Objective To study the effective treatment for patients with benign prostate hyperplasia ( BPH) complicated with bladder stones. Methods The clinical data of 32 cases with BPH complicated with bladder stones treated by transurethral holmium: YAG laser lithotripsy and dual probe lithotripsy combined with transurethral plasmakinetic vaporization of prostate (TUPKVP) were reviewed retrospectively. Results Thirty of 32 cases were successfully operated with endourological treatment simultaneously. The other 2 cases were first given TUPKVP treatment for BPH, and then given minor incision operation because of hard big bladder stones, severe edema of bladder mucosa and over operation time. The mean lithoclasty time was 24 min (10 ～50 min). Mean TUPKVP with electrocision time was 65 min (35 ～ 110 min). Mean amount of blood transfusion was 120mL (80 ～200 ml). No TUR syndrome or bladder perforation occurred during operations. Urethral catheter were withdrawn in several days after operation, none of the patients showed urinary incontinence, dys-uria or residual stones. Follow-up was made 6 months after surgery,no urethral stricture or bladder stone recurrence case was reported. International prostate symptom scores,maximum flow rate and quality of life score were obviously improved during postoperation than preop-eration. Conclusions Transurethral holmium: YAG laser lithotripsy and dual probe lithotripsy combined with TUPKVP is both save and effective in the treatment of BPH with bladder stones. It has less invasion, faster recovery, fewer complications, shorter hospital stay and lower costs. Dual probe lithotripsy can especially clean up large bladder stones. So it is an ideal method to treat those patients with BPH complicated with bladder stones.
