颜锡欣 洪志坚 姚锦树

[摘要] 目的 探析針对前列腺增生合并膀胱结石患者采用等离子电切镜联合输尿管镜下钬激光碎石与前列腺等离子切除术治疗的临床效果。方法 方便择取2013年4月—2017年4月该院收治的33例前列腺增生合并膀胱结石患者进行研究，所选患者在接受连续硬膜外麻醉后，利用电切镜外鞘将Wolf F8.0/9.8硬性输尿管镜置入，分别从输尿管镜镜鞘进水孔、电切镜外鞘进水和出水。通过活动离子电切镜外鞘对膀胱结石进行确定，再从输尿管镜操作通道将钬激光碎石操作件置入，将膀胱结石碎成小块，对已经破坏的结石用Ellik冲洗器冲洗出膀胱外。将等离子电切镜操作件置入，予以前列腺等离子切除术。对患者一次治疗成功率、并发症、结石清除率、IPSS评分、QOL评分、Qmax、随访结果进行分析。结果 所选患者均一次治疗成功，并且未出现严重并发症。术后复查结果显示无结石残留，结石清除率100%。术后IPSS评分为（9±2.0）分，QOL评分为（2.4±1.1）分，明显低于术前，Qmax为（18.1±6.1）mL/s，明显高于术前。对患者进行为期1～24个月的术后随访，并未发现远期并发症，且无复发。 结论 针对前列腺增生合并膀胱结石患者采用等离子电切镜联合输尿管镜下钬激光碎石与前列腺等离子切除术治疗可以取得良好效果。

[关键词] 等离子电切镜；输尿管镜下钬激光碎石；前列腺等离子切除术；前列腺增生；膀胱结石

[中图分类号] R765 [文献标识码] A [文章编号] 1674-0742（2018）01（a）-0067-03

Plasma Resectoscope Combined with Ureteroscopic Holmium Laser Lithotripsy and Prostatic Plasmapheresis for Benign Prostatic Hyperplasia with Bladder Calculi in 33 Cases

YAN Xi-xin， HONG Zhi-jian， YAO Jin-shu

Department of Urinary Surgery， Jinjiang Hospital of Traditional Chinese Medicine， Jinjiang， Fujian Province， 362200 China

[Abstract] Objective This paper tries to investigate the clinical effect of transurethral resection of holmium laser lithotripsy combined with transurethral plasmakinetic resection of prostate for patients with benign prostatic hyperplasia complicated with bladder calculi. Methods The study was performed in 33 cases of benign prostatic hyperplasia complicated with bladder stones from April 2013 to April 2017 in the hospital， the convenient selected patients received continuous epidural anesthesia in use， the outer sheath of resectoscope Wolf F8.0/9.8 rigid ureteroscope insertion， respectively from the ureteroscope sheath into the hole， the outer sheath of resectoscope inlet and outlet. Through the activities of ions in the outer sheath of resectoscope for bladder calculi were determined from ureteroscopic holmium laser lithotripsy operation channel operation into small pieces， stones， stones of the already damaged by Ellik wash rinse bladder outside. The plasma electrosurgical cutter was inserted into the prostate and performed transurethral resection of the prostate. The success rate， complications， stone clearance rate， IPSS score， QOL score， Qmax and follow-up results of the patients were analyzed. Results The selected patients were treated successfully and without severe complications. The result of postoperative re examination showed no residual stones， and the stone clearance rate was 100%. The postoperative IPSS score was（9±2.0）points， and the QOL score was （2.4±1.1）points， which was significantly lower than that before the operation， and Qmax was （18.1±6.1）mL/s， which was significantly higher than that before the operation. The patients were followed up for 1～24 months without any long-term complications and no recurrence. Conclusion For benign prostatic hyperplasia with bladder stones in patients with plasma resectoscope combined with ureteroscopic holmium laser lithotripsy and prostate plasma resection can achieve good results.

[Key words] Plasma microscopy； Holmium laser lithotripsy under ureteroscope； Transurethral resection of prostate； Prostatic hyperplasia； Bladder calculi

在泌尿系结石中，膀胱结石较为常见，特别是前列腺增生合并膀胱结石，对于此，泌尿外科通常采取腔内手术的方式进行治疗[1]。……