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目的:探讨高龄高危大体积前列腺增生(BPH)合并膀胱大结石行改良经尿道腔内剜除(M-PKEP)联合膀胱切开取石同期手术治疗的安全性和有效性。方法:将129例高龄高危大体积BPH患者随机分为观察组(M-PKEP联合膀胱切开取石)59例和对照组(TURP联合钬激光碎石)70例。对两组术中及术后相关指标变化值进行比较。结果:129例均顺利完成手术。观察组和对照组手术时间分别为(70.9±8.2)min、(169.9±30)min(P<0.01);术中出血量分别为(78.1±11.5)ml、(159.3±30.6)ml(P<0.01);前列腺切除质量和比例分别为(86.2±18.2)g和(73.2±6.9)%、(67.5±10.6)g和(55.3±7.1)%(P<0.05);术后膀胱持续冲洗时间分别为(45.2±13.2)h、(69.2±16.6)h(P<0.01);术后尿失禁发生比例两组分别为0/59和12/70。术后随访6个月,两组术后IPSS、最大尿流率、剩余尿量较术前均显著改善(P<0.01)。组间比较术后1个月观察组IPSS改善优于对照组(P<0.01),术后6个月剩余尿量改善优于对照组(P<0.01)。所有患者术后6个月复查B超未见结石残留和复发。结论:M-PKEP联合膀胱切开取石手术安全性高,并发症少,疗效显著,适用于高龄高危大体积BPH合并膀胱大结石的治疗,值得临床进一步推广。
Objective: To investigate the safety and efficacy of concurrent high-risk high-risk massive benign prostatic hyperplasia (BPH) combined with bladder stones in the treatment of modified transurethral resection of the urethra (M-PKEP) combined with cystectomy. Methods: A total of 129 high-risk and high-risk BPH patients were randomly divided into observation group (M-PKEP combined with cesarean section) and control group (TURP + holmium laser lithotripsy) in 70 cases. The changes of the related indexes in the two groups during and after surgery were compared. Results: All 129 cases completed the operation smoothly. The operative time in the observation group and the control group were (70.9 ± 8.2) min and (169.9 ± 30) min, respectively (P <0.01). The intraoperative blood loss were (78.1 ± 11.5) ml and (159.3 ± 30.6) 0.01). The quality and proportion of prostate resection were (86.2 ± 18.2) g and (73.2 ± 6.9)%, (67.5 ± 10.6) and (55.3 ± 7.1)%, respectively (45.2 ± 13.2) h, (69.2 ± 16.6) h (P <0.01). The incidence of postoperative urinary incontinence was 0/59 and 12/70 respectively. The patients were followed up for 6 months. The IPSS, maximal uroflow rate and residual urine volume were significantly improved in both groups after operation (P <0.01). The improvement of IPSS in observation group was better than that in control group (P <0.01) at one month after operation. The improvement of residual urine volume at 6 months after operation was better than that of control group (P <0.01). All patients 6 months after the review B-no residual stones and recurrence. Conclusions: M-PKEP combined with cystectomy is safe and has few complications and significant curative effect. It is suitable for the treatment of high-risk and large-volume BPH combined with large bladder stones in elderly patients, and is worth further promotion in clinic.