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目的:探讨经尿道铥激光联合第四代EMS碎石清石系统同期治疗高危前列腺增生(BPH)并发膀胱结石的疗效及安全性。方法:回顾性分析2011年2月~2013年4月我院收治的38例高危BPH合并膀胱结石患者临床资料,所有患者均首先应用第四代EMS碎石清石系统粉碎并清除结石,再用铥激光汽化切除增生前列腺组织。分别统计碎石手术时间及总体手术时间,观察术中及术后并发症发生情况。比较患者手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、膀胱剩余尿量(RUV)的变化。结果:38例患者均手术成功,术中、术后未出现明显并发症,碎石时间平均23min,手术总体时间平均110min,拔除尿管后患者均排尿畅,无尿失禁。术后随访6个月,IPSS评分由术前(24.15±2.90)降至(7.18±3.32),QOL评分由术前(6.21±2.03)分降至(1.11±1.42)分,差异有统计学意义(P<0.01);Qmax由术前(6.71±2.02)ml/s增至术后(13.20±1.97)ml/s,RUV由术前(15.64±7.33)ml降至术后(6.18±6.92)ml,差异有统计学意义(P<0.01)。结论:联合应用铥激光及第四代EMS碎石清石系统治疗BPH伴膀胱结石具有并发症少、疗效确切的优点,尤其适合在高龄、体质差、基础疾病多的患者间推广。
Objective: To investigate the efficacy and safety of transurethral laser combined with the fourth generation of EMS gravel system in the treatment of high-risk benign prostatic hyperplasia (BPH) complicated with bladder stones. Methods: The clinical data of 38 patients with high-risk BPH complicated with bladder stones admitted to our hospital from February 2011 to April 2013 were retrospectively analyzed. All patients were firstly crushed and cleared of stones by the fourth generation of EMS gravel system,铥 laser vaporization of prostate hyperplasia. The gravel operation time and total operation time were separately counted to observe the intraoperative and postoperative complications. The changes of International Prostate Symptom Score (IPSS), Quality of Life Score (QOL), Maximum Urine Flow Rate (Qmax) and Residual Bladder Urine Volume (RUV) were compared before and after the operation. Results: All the 38 patients were operated successfully. There was no obvious complication during and after operation. The average time of gravel was 23min and the average time of operation was 110min. The patients underwent urinary incontinence after extubation. After 6 months of follow-up, the IPSS score decreased from (24.15 ± 2.90) to (7.18 ± 3.32) before surgery and the QOL score decreased from 6.21 ± 2.03 to 1.11 ± 1.42 before surgery, the difference was statistically significant (P <0.01). Qmax increased from 6.71 ± 2.02 ml / s to 13.20 ± 1.97 ml / s preoperatively, and the RUV decreased from 15.64 ± 7.33 ml to 6.18 ± 6.92% ml, the difference was statistically significant (P <0.01). Conclusion: The combined application of laser and the fourth generation of EMS lithotripsy lithotripsy BPH with bladder stones with less complications, the exact effect of the advantages, especially for advanced age, poor quality, basic disease and more patients between the promotion.