摘要:
目的 比较同期微创术与分期微创术治疗前列腺增生合并中下段输尿管结石的治疗效果.方法 选取兰溪市人民医院2016年8月至2017年8月收治的前列腺增生合并输尿管下段结石患者76例为观察对象,采用随机数字表法分为对照组与观察组各38例,对照组采取分期微创术治疗,观察组则给予同期微创术治疗,比较两组手术情况,统计两组术后7d并发症发生情况,观察两组患者术前、术后3个月的前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(RU)、最大尿流率(MFR)的变化情况,术后3个月时调查患者对于治疗的满意程度.结果 观察组和对照组术中出血量分别为(101.29±10.01) mL和(187.62±11.69)mL,手术总用时分别为(140.12±9.81)min和(163.98±10.07) min,住院时间分别为(8.12±0.73)d和(13.49±1.21)d,差异均有统计学意义(t=34.579、10.462、23.425,均P<0.05).治疗前两组患者的MFR、RU、IPSS、QOL差异均无统计学意义(均P>0.05);治疗后对照组和观察组患者MFR分别为(19.04±2.17) mL/s和(18.87±2.00) mL/s,RU分别为(30.67±8.19)mL和(29.51±8.06) mL,IPSS分别为(8.47±1.06)分和(8.53±1.02)分,QOL分别为(2.69±0.68)分和(2.58±0.61)分,均显著改善(组内比较t=27.971和28.809,74.327和74.941,33.440和33.670,12.122和14.589,均P<0.05);治疗后两组患者上述各项指标差异均无统计学意义(t=0.352、0.622、0.251、0.742,均P>0.05).术后7d内,观察组并发症总发生率为31.58%(12/38),对照组并发症总发生率为21.05% (8/38),两组差异无统计学意义(x2=1.086,P>0.05).观察组患者满意率为81.58%(31/38),总满意率为97.37%(37/38);对照组患者满意率为47.37%(18/38),总满意率为76.32% (29/38);观察组患者满意度优于对照组(Z=-3.290,P<0.05).结论 同期微创术治疗前列腺增生合并中下段输尿管结石,疗效确切,并可减少术中出血量、缩短手术总用时和住院时间,术后恢复更快,患者满意度更高,值得临床推广.%Objective To compare the efficacy of simultaneous minimally invasive surgery and staged minimally invasive surgery in the treatment of benign prostatic hyperplasia (BPH) with lower ureteral junction.Methods From August 2016 to August 2017,76 cases of BPH complicated with lower ureteral junction in Lanxi People's Hospital were selected.According to random number table method,the patients were randomly divided into control group and observation group.The control group received the stage of minimally invasive treatment,the observation group was treated with minimally invasive surgery.The incidence of complications 7d after operation was observed.Before operation and 3 months after operation,the prostate symptom score (IPSS),quality of life score (QOL),residual urine volume (RU),maximum urinary flow rate (MFR) were observed in the two groups.The patients' satisfaction with the treatment was investigated in the two groups.Results The amount of blood loss,total operation time,hospitalization time of the observation group and control group were (101.29 ± 10.01) mL vs.(187.62 ± 11.69)mL,(140.12 ±9.81)min vs.(163.98 ± 10.07) min,(8.12 ±0.73) d vs.(13.49 ± 1.21) d,the differences were statistically significant (t =34.579,10.462,23.425,all P < 0.05).Before treatment,the MFR,RU,IPSS and QOL between the two groups had no statistically significant differences (all P > 0.05).Mter treatment,the MFR,RU,IPSS and QOL of the control group and observation group were (19.04 ± 2.17) mL/s vs.(18.87 ± 2.04) mL/s,(30.67 ± 8.19) mL vs.(29.51 ± 8.06) mL,(8.47 ± 1.06) points vs.(8.53 ± 1.02) points,(2.69 ± 0.68) points vs.(2.58 ± 0.61) points,the MFR,RU,IPSS and QOL were significantly improved (t =27.971 and 28.809,74.327 and 74.941,33.440 and 33.670,12.122 and 14.589,all P <0.05).After treatment,there were no statistically significant differences in the above indicators between the two groups (t =0.352,0.622,0.251,0.742,all P > 0.05).Postoperative 7 days,the incidence rate of complications of the observation group was 31.58% (12/38),which of the control group was 21.05% (8/38),there was no statistically significant difference between the two groups (x2 =1.086,P > 0.05).The satisfaction rate of the observation group was 81.58% (31/38),the total satisfaction rate was 97.37% (37/38).The satisfaction rate of the control group was 47.37% (18/38),and the total satisfaction rate was 76.32% (29/38).The satisfaction of the observation group was better than that of the control group(Z =-3.290,P < 0.05).Conclusion The curative effect of minimally invasive surgery in the treatment of BPH with middle and lower ureteral calculi is exact,and can reduce the amount of bleeding,shorten operation time and total hospitalization time,faster postoperative recovery in patients with higher satisfaction,it is worthy of clinical promotion.