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目的探讨良性前列腺增生症(BPH)并膀胱结石的有效治疗方法。方法 27例BPH合并膀胱结石患者分别采用经尿道前列腺电切术(TURP)结合电切环结石勾出和(或)冲出(A组,7例)、经尿道前列腺电切术结合体外冲击波碎石术(ESWL)(B组,6例)、耻骨上膀胱切开取石术+前列腺增生部摘除术(C组,14例)治疗。结果 27例均手术成功,除1例开放手术后膀胱裂开,二次缝合改置膀胱造瘘管出院后因其他原因死亡外,术后拔管后均排尿正常。A组和B组术后膀胱冲洗时间、留置尿管时间及住院时间明显少于C组。A组和B组无明显手术并发症,而C组中3例出现并发症,分别是脑梗死、继发大出血、切口裂开。结论良性前列腺增生症合并膀胱结石的治疗有多种安全、有效的方法,可根据具体情况选择合适的手术方式。采用TURP结合ESWL创伤小,术后恢复快,住院时间短,达到现代外科的微创治疗目的。而开放手术在前列腺较大、结石较大或为多发情况下采用仍不失为基层医院的一种好办法,但要尽量避免术中、术后并发症的发生。
Objective To investigate the effective treatment of benign prostatic hyperplasia (BPH) and bladder stones. Methods Twenty-seven patients with BPH complicated with bladder stones were treated with TURP combined with electrocorticotomy (A group, 7 cases). Transurethral resection of the prostate combined with extracorporeal shock wave Stone surgery (ESWL) (group B, 6 cases), suprapubic cystectomy + prostate hyperplasia (group C, 14 cases). Results All the 27 cases were operated successfully. Except one case of bladder rupture after open surgery and secondary suture replacement of bladder fistula after discharge for other causes of death, all patients had regular urination after extubation. The bladder irrigation time, indwelling catheterization time and hospital stay in group A and group B were significantly less than those in group C. There was no obvious complication in group A and group B, but in group C, 3 cases were complicated with cerebral infarction, secondary hemorrhage and incision. Conclusion The treatment of benign prostatic hyperplasia with bladder stones have a variety of safe and effective method, according to the specific circumstances to choose the appropriate surgical approach. TURP combined with ESWL trauma, fast recovery, shorter hospital stay, to achieve the purpose of minimally invasive modern surgical treatment. The open surgery in the larger prostate, large stones or multiple cases are still used as a primary hospital is a good way, but to try to avoid intraoperative and postoperative complications.