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目的评估改进型电切镜联合钬激光同步治疗良性前列腺增生(BPH)合并膀胱结石的疗效,以寻找同步治疗BPH合并膀胱结石的最佳方法。方法选取2011年6月—2016年6月在上海市静安区闸北中心医院泌尿外科住院治疗的前列腺增生合并膀胱结石患者204例,根据随机数字表法将患者分为A、B、C 3组,每组68例患者,分别接受电切镜鞘联合输尿管镜下气压弹道治疗、电切镜鞘联合输尿管镜下钬激光治疗与改进型电切镜联合钬激光治疗。比较3组患者的围手术情况、并发症发生情况,并对患者进行6个月、12个月随访,比较3组患者的预后指标。结果 B组、C组患者结石一次性碎石成功率、结石排净率、总手术时间、碎石手术时间优于A组(P均<0.05),C组患者以上指标显著优于B组(P均<0.05)。与术前比较,3组患者6、12个月的国际前列腺症状评分(IPSS)、最大尿流率(Q_(max))与残余尿(PVRU)值较基线值均显著改善(P<0.01)。术后第6、12个月,3组间同期IPSS、Q_(max)、PVRU、国际勃起功能指数(IIEF)比较差异无统计学意义(P>0.05)。3组患者并发症发生率比较差异有统计学意义(χ~2=40.372,P<0.01),C组并发症发生率低于A组(χ~2=34.638,P<0.01),亦低于B组(χ~2=7.496,P=0.006)。结论钬激光治疗膀胱结石较气压弹道碎石效率更高,而改进后的新型电切镜联合钬激光治疗良性前列腺增生合并膀胱结石操作简便,手术时间缩短,并发症少,是一种安全、有效的新型泌尿外科手术方法。
Objective To evaluate the efficacy of modified resectoscope combined with holmium laser in the treatment of benign prostatic hyperplasia (BPH) complicated with bladder stones in order to find out the best method for simultaneous treatment of BPH with bladder stones. Methods From June 2011 to June 2016, 204 patients with benign prostatic hyperplasia and bladder stones hospitalized in Department of Urology, Zhabei Central Hospital, Jing’an District, Shanghai were divided into A, B and C groups according to random number table method, Each group of 68 patients were treated with electroretinography combined with ureteroscopic pneumatic ballistics, combined with combined resection of the ureteroscope and ureteroscopic holmium laser and modified resectoscope with holmium laser. The perioperative conditions and complications of the three groups were compared. The patients were followed up for 6 months and 12 months. The prognostic indicators of the three groups were compared. Results The success rate of stones, stones removal rate, total operation time and gravel operation time in group B and group C were better than those in group A (all P <0.05). The above indexes in group C were significantly better than those in group B P <0.05). Compared with the preoperative values, the IPSS, Q max and PVRU of 6 months and 12 months group were significantly improved (P <0.01) . There were no significant differences in IPSS, Q max, PVRU and IIEF between the three groups at 6 and 12 months after operation (P> 0.05). The incidence of complications in the three groups was significantly different (χ ~ 2 = 40.372, P <0.01). The incidence of complications in group C was lower than that in group A (χ ~ 2 = 34.638, P <0.01) Group B (χ ~ 2 = 7.496, P = 0.006). Conclusions Holmium laser is more effective than pneumatic lithotripsy in the treatment of bladder stones. However, the new modified resectoscope and holmium laser combined with holmium laser to treat benign prostatic hyperplasia with bladder stones are simple and easy to operate, the operation time is shortened, and the complications are less, which is a safe and effective method New urological surgery method.