内镜一次性治疗前列腺增生症合并膀胱结石体会.docVIP

内镜一次性治疗前列腺增生症合并膀胱结石体会[摘要] 目的：观察分析内镜一次性治疗前列腺增生症合并膀胱结石的效果。方法：本组35例患者先行膀胱结石钬激光碎石，然后采用经尿道等离子体双极前列腺电切术（（PKRP）治疗前列腺增生症。结果：35例一次性治疗成功，术后结石无残留，排尿情况较前明显改善，IPSS评分均分由25.4分降到10.3分，尿流率由8.5 ml/s上升到18 ml/s，1例出现尿道外口狭窄，经尿道扩张后改善。结论：钬激光碎石及PKRP同期治疗前列腺增生合并膀胱结石是安全有效的方法。 [关键词] 前列腺增生；钬激光；经尿道等离子双极前列腺电切术；膀胱结石 [中图分类号] R697+.32[文献标识码]C [文章编号]1674-4721（2010）10（c）-175-02 Experience of surgical treatment of prostatic hyperplasia(BPH) with bladder stones by endoscopy one-time XU Qian, TAN Shubin, ZHU Hui (Department of Urology, Third Affiliated Hospital of Nantong University, Jiangsu Province,Nantong 226006China) [Abstract] Objective: To observe and analyze the effect of surgical treatment of benign prostactic hyperplasia(BPH) with bladder stones by endoscopy one-time. Methods: Holmium laser was used for bladder stones, and then transurethml plasmakinetic resection of prosate (PKRP)for BPH in 35 patients. Results: The 35 cases were done well at one-time. The stones were broken well and the patient’s urination was smooth, the international prostate symptom score (IPSS)decreased from 25.4 to 10.3 and the peak flow rate of urine increased from 8.5 ml/s to 18 ml/s, only one case urethral stenosis, and became well after urethral dilation. Conclusion: Holmium laser and PKRP operating for BPH with bladder stones at one-time is safty and effective. [Key words] Prostatic hyperplasia; Holmium laser;Transurethml plasmakinetic resection of prosate; Bladder stones 本院2008年8月～2009年12月共收治前列腺增生症合并膀胱结石患者35例，采用经尿道等离子体双极前列腺电切术（（PKRP）治疗前列腺增生症，钬激光治疗膀胱结石，取得良好效果，现将体会总结如下： 1 资料与方法 1.1 一般资料 本院2008年8月～2009年12月共收治前列腺增生症合并膀胱结石患者35例，年龄67～85岁，前列腺体积为35.6～ 80.5 g，单发结石22 例，多发结石 13例，结石大小为1.5 cm×1.2 cm~3.5 cm×3 cm，IPSS评分为19～30分，平均为25.4分，尿流率为7 ～13 ml，平均为8.5 ml/s，合并高血压 15例，冠心病 8例，糖尿病7 例，泌尿系感染3 例。 1.2 方法 术前完善术前准备，首先控制尿路感染，将血压、血糖控制到一定范围内，并评判患者的心、肺、肾功能等，采取硬膜外麻醉，取截石位，F21wolf膀胱镜直视下进入膀胱，用钬激光碎石，碎石功率为18～25 W，将膀胱结石碎成细颗粒，改用F25.8等离子电切镜，用ELICK吸出碎石末，再切除增生前列腺，切割功率为160～180 W，止血功率80～90 W，深达外科包膜，内至膀胱颈，外达括约肌，止血彻底，