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目的:探讨BPH并膀胱结石患者经尿道腔内碎石的高效方法。方法:对BPH并膀胱结石患者280例,行经尿道腔内碎石治疗,术中均先行碎石,采用大力碎石钳碎石150例(Ⅰ组),气压弹道碎石55例(Ⅱ组),钬激光碎石75例(Ⅲ组);如碎石成功再行前列腺电汽化术切除前列腺(TVP)。结果:Ⅰ组、Ⅱ组、Ⅲ组碎石成功率分别为57.3%、67.3%、98.7%;术中发生膀胱损伤、穿孔率20.0%、1.8%、0%,因膀胱穿孔改为开放手术率2.7%、0%、0%,结石无法粉碎改为开放手术率40%、32.7%、1.3%,术后6月尿道狭窄发生率18%、5.5%、2.7%。改为开放手术患者均行耻骨上膀胱切开取石及前列腺摘除术,余碎石失败患者均行TVP并耻骨上膀胱切开取石。Ⅲ组与Ⅰ组、Ⅱ组碎石成功率、结石无法粉碎改开放手术率比较,差异有统计学意义(P<0.05);Ⅰ组与Ⅱ组、Ⅲ组术中并发症发生率及术后尿道狭窄发生率比较,差异有统计学意义(P<0.05)。结论:经尿道钬激光碎石治疗BPH并膀胱结石是一种安全、高效的方法,可以作为首选。
Objective: To explore the efficient method of transurethral lithotomy in patients with BPH and bladder stones. Methods: A total of 280 patients with BPH and bladder stones underwent transurethral endoscopic lithotripsy. All the patients underwent primary lithotripsy with gravel forceps lithotripsy (group Ⅰ) and pneumatic lithotripsy (group Ⅰ, n = 55) (group Ⅱ) , Holmium laser lithotomy in 75 cases (group Ⅲ); such as the success of gravel prostate resection of the prostate (TVP). Results: The success rates of gravel in group Ⅰ, group Ⅱ and group Ⅲ were 57.3%, 67.3% and 98.7%, respectively. Bladder injury occurred during operation with perforation rates of 20.0%, 1.8% and 0% 2.7%, 0%, 0%. The stone can not be crushed to open surgery rate of 40%, 32.7%, 1.3%, postoperative urethral stricture in 18%, 5.5%, 2.7%. To open surgery patients underwent suprapubic cystolithotomy and prostatectomy, patients with residual stone failure were performed TVP and suprapubic cystolithotomy. Group Ⅲ and Ⅰ, Ⅱ gravel success rate, stone can not be crushed to change the rate of open surgery, the difference was statistically significant (P <0.05); Ⅰ and Ⅱ, Ⅲ group the incidence of postoperative complications and postoperative The incidence of urethral stricture, the difference was statistically significant (P <0.05). Conclusions: Transurethral holmium laser lithotripsy for the treatment of BPH and bladder stones is a safe and effective method and may be the first choice.