微创泌尿外科杂志

目的:比较不同前列腺体积的前列腺增生症患者采用经尿道双极等离子前列腺电切术与经尿道双极等离子前列腺剜除术治疗的临床效果及安全性。方法:收集2011年2月~2016年3月随访截止的521例良性前列腺增生患者并进行前瞻性对比研究,通过随机分组法将所有患者根据前列腺体积大小分成两组,前列腺体积<100ml的380例作为一组,其中行电切术的有182例,行剜除术的有198例;前列腺体积>100ml的141例作为另一组,其中行电切术的78例,行剜除术的63例。术后随访3个月。观察和记录两组患者中行不同手术的手术情况、术后并发症发生情况并进行比较分析。结果:两组间行不同手术方法术前相比,在年龄、前列腺体积、PSA水平、国际前列腺症状(IPSS)评分、生活质量(QOL)评分,最大尿流率方面均差异无统计学意义。前列腺体积<100ml组,剜除术切除前列腺组织更多,术中出血更少,术后IPSS评分、QOL评分、剩余尿量、最大尿流率改善更明显(P<0.05)。但是假性尿失禁占比更多(P<0.05)。前列腺体积>100ml组,剜除术切除前列腺组织更多,术后IPSS评分、QOL评分、剩余尿量、最大尿流率改善更明显(P<0.05)。但是术中出血增多,假性尿失禁发生率及术后迟发性出血更多(P<0.05)。结论:经尿道双极等离子前列腺剜除术较电切术切除前列腺更彻底,术后排尿改善更明显。但是剜除术术后假性尿失禁发生率增加,在治疗大体积前列腺时,术中出血量及术后迟发性出血发生率也会增加。剜除术不能完全取代电切术。

Objective:To compare the clinical safety and efficiency of transurethral bipolar plasmakinetic resection of the prostate(PKRP)vs.transurethral plasmakinetic enucleation of prostate(TPKEP)for benign prostatic hyperplasia(BPH)according to different volumes of prostate.Methods:521patients with lower urinary tract symptoms complicated with BPH were prospectively studied from February 2010 to March 2016.They were divided into two groups randomly according to the volume of the prostate.One group with volume being less than 100 mL included 380 cases,and the other group with volume being more than 100 mL included 141 cases.In less than100 mL group,182 cases underwent PKRP and 192 cases underwent TPKEP.In more than 100 mL group,78 cases were subjected to PKRP and 63 cases to TPKEP.All patients were preoperatively assessed and evaluated at3 rd month after surgery.The perioperative data and postoperative outcomes were compared.Postoperative complications were recorded.Results:No statistically significant differences in age,prostate volume,International Prostate Symptom Score(IPSS),quality of life(QOL),post void residual urine(PVRU)volume,and maximum flow rate(Qmax)were seen between the two groups preoperatively.In less than 100 mL group,more resected prostate tissues and less blood loss were seen by means of TPKEP than PKRP.Furthermore,IPSS,QOL,PVRU and Qmax were improved dramatically by means of TPKEP than the counterpart(P<0.05).However,the incidence of false incontinence of TPKEP was higher than that of PKRP(P<0.05).In more than 100 mL group,more resected prostate tissues were also seen by means of TPKEP than PKRP.Furthermore,IPSS,QOL,PVRU and Qmax were also improved dramatically(P<0.05).However,more intraoperative blood loss was seen,as well as the incidence of postoperative delayed hemorrhage and false incontinence for TPKEP were higher than those for PKRP(P<0.05).Conclusions:TPKEP is a safe and effective method for the transurethral management of BPH.TPKEP resects the prostate more entirely than PKRP,which causes more fluent urination.However,false incontinence for TPKEP is higher than that for PKRP.And more intraoperative blood loss and postoperative delayed hemorrhage are seen for large BPH.TPKEP can't replace PKRP completely.