气压弹道碎石及汽化电切治疗前列腺增生并膀胱结石体会.docVIP

气压弹道碎石及汽化电切治疗前列腺增生并膀胱结石体会【摘要】 目的 探讨前列腺增生并膀胱结石的有效治疗方法。方法 采用经尿道输尿管镜下气压弹道碎石和汽化电切治疗前列腺增生并膀胱结石共10例。结果 手术时间60~120 min,术后7~9 d拔管,排尿通?,无TURS,大出血,膀胱穿孔等并发症。结论 输尿管镜下气压弹道碎石和汽化电切是治疗前列腺增生并膀胱结石的一种安全有效的方法。 【关键词】前列腺增生;膀胱结石;汽化电切术;气压弹道碎石 Pneumatic lithotripsy and transurethral electrovaporization of the prostate in bladder calculus with benign prostate hyperplasia YU Hong-tao,FANG Jun,ZUO Ze-ping.Department ofUrology,the People’s Hospital of Tongling,Tongling,Anhui,Tongling 244000,China 【Abstract】 Objective To evaluate the effective therapy methods in bladder calculi with benign prostatic hyperplasia.Methods Using pneumatic lithotripsy and transurethral electrovaporization of the prostate in 10 cases with bladder stones and benign prostatic hyperplasia.Results The average operative time was 100 minutes(range 60-120 minutes).All patients were withdrawn Foley catheter and voiding easy and smooth.None had complications such as transurethral resection syndrome,hemorrhea and vesical perforation.Conclusion Combination of pneumatic and transurethral electrovaporization of the prostate that is safe and effective in the treatment of bladder calculi with benign prostate hyperplasia. 【Key words】Benign prostatic hyperplasia; Bladder calculi; Transurethral electrovaporization of the prostate; Pneumatic lithotripsy DOI:10.3760/cma.j.issn 1673-8799.2010.06.81 作者单位:244000安徽省铜陵市人民医院泌尿外科 前列腺增生并膀胱结石临床上常采用经尿道碎石同时行前列腺电切术,对部分较大膀胱结石采用膀胱切开取石联合前列腺电切术。2006年2月至2008年10月本院采用输尿管镜下气压弹道碎石和汽化电切治疗前列腺增生并膀胱结石共10例,取得满意效果,现报告如下。 1 临床资料和方法 1.1 一般资料 本组10例,年龄60~75岁,平均67岁,均有典型的BPH症状.国际前列腺症状评分IPSS22~30分,残余尿量60~200 ml.游离psa均在正常?围。其中高血压6例,慢性支气管炎2例,术前经直肠指检,B超,KUB+IVP,尿道膀胱镜检,尿动力学检查均提示前列腺增生并膀胱结石。其中膀胱多发结石2例,单发8例,结石最大2.5 cm,最小1.0 cm。 1.2 治疗方法 患者取截石位,在硬膜外阻?麻醉联和腰麻下,先用Hawk电切镜经尿道入膀胱,在显示屏监视下观察精阜、前列腺及膀胱,观察前列腺增生情况,了解膀胱?有无肿瘤及憩室,观察结石大小及数目。再退出电切镜,置入输尿管镜及碎石探杆,依次将结石粉碎,用Ellik冲洗出击碎的结石。再退出输尿管镜后置入电切镜,用铲式电极行前列腺汽化电切,汽化功率200 w,电凝功率80 w,采用4%甘露醇液连续冲洗。前列腺切除采用分叶切除法,先于6点取纵行标志沟,远端达精阜,近端达膀胱颈,依次切除前列腺左叶。右叶及后唇部,最后修剪前列腺尖部腺体,留置20F三