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目的探讨微创治疗高龄高危并膀胱结石的前列腺增生(BPH)患者的围术期处理体会。方法回顾性分析56例80岁以上、一种以上慢性合并症的BPH并膀胱结石患者的临床资料。其中合并糖尿病16例,冠心病11例,高血压病8例,慢性呼吸道感染7例,肾功能损害48例,尿路感染等;2种合并症19例,3种合并症11例,均采用前列腺电切(TURP)术联合钬激光碎石术,术前进行充分的术前准备和术后处理。结果 1例术中出现高血压危象,3例出现经尿道电切综合征(TURS),术后随访6个月~1年,国际前列腺症状评分(IPSS)由术前32降到7.0,生活质量评分(QOS)和最大尿流率(Qmax)均有显著改善。结论高龄高危合并膀胱结石BPH患者不能作为微创手术的禁忌,只要做好充分的术前准备和术中、术后处理,切实有效地控制合并症,微创手术是安全、有效的。
Objective To investigate the perioperative management of patients with benign prostatic hyperplasia (BPH) treated by minimally invasive treatment of advanced age and bladder stones. Methods Retrospective analysis of 56 cases of 80 years of age or more, more than one chronic complications of BPH and bladder stones in patients with clinical data. Among them, 16 cases were complicated with diabetes mellitus, 11 cases were coronary heart disease, 8 cases were hypertension, 7 cases were chronic respiratory infection, 48 cases were renal dysfunction, urinary tract infection and so on. 2 kinds of comorbidities were 19 cases and 3 kinds of complications were 11 cases Surgical resection of prostate (TURP) combined with holmium laser lithotripsy, preoperative and adequate preoperative preparation and postoperative treatment. Results One case had hypertriglyceridemia and three cases had TURS. The patients were followed up for 6 months to 1 year. The International Prostate Symptom Score (IPSS) decreased from 32 before surgery to 7.0. Quality scores (QOS) and maximum flow rate (Qmax) were significantly improved. Conclusion High-risk BPH patients with bladder stones can not be contraindicated in minimally invasive surgery. Minimally invasive surgery is safe and effective as long as adequate preoperative preparation, intraoperative and postoperative management, and practical control of comorbidities are effective.