经尿道前列腺等离子腔内剜除术治疗大体积良性前列腺增生的临床疗效

Efficacy of plasmakinetic enucleation for massive benign prostatic hyperplasia

目的分析经尿道前列腺等离子腔内剜除术(PKEP)治疗大体积(>80 ml)良性前列腺增生(BPH)的临床疗效。方法回顾性分析2009年3月至2013年2月128例行PKEP或经尿道前列腺双极电切术(TUPKP)治疗的大体积BPH患者的临床资料,并于术后第1、3、6个月进行随访。结果 PKEP组(72例)和TUPKP组(56例)患者年龄、病程、前列腺体积差异无统计学意义(P>0.05);手术时间分别为(93.7±27.5)min和(89.8±22.4)min,差异无统计学意义(P>0.05)。前列腺切除质量和比例分别为(64.2±22.1)g和(52.7±28.6)g、(64.17±10.15)%和(54.45±9.62)%,术后膀胱冲洗和导尿管留置时间、住院天数分别为(20.7±6.5)h和(29.6±8.3)h、(4.3±1.5)d和(5.6±2.1)d、(5.2±1.4)d和(6.5±1.9)d,各有并发症3例和9例,各项指标组间比较差异均有统计学意义(P<0.05);2组患者术前及术后第3个月随访时残余尿量(RUV)、最大尿流率(Qmax)、国际前列腺症状评分(I-PSS)、生活质量指数(QOL)评分组间比较,差异均无统计学意义(P>0.05),但各指标均较术前明显改善(P<0.05)。结论 PKEP术治疗大体积BPH的近期疗效、手术时间与TUPKP术相似;但其有效性、彻底性和安全性优于TUPKP术。

Objective To analyze the efficacy of plasmakinetic enueleation for massive benign prostatic hyperplasia, and compare with the transurethral bipolar plasma kinetic prostatectomy. Methods One hundred and twenty-eight cases of massive benign prostatic hyperplasia who were treated with plasmakinetic enucleation （the PKEP group, n=72） or transurethral bipolar plasma kinetic prostateetomy （the TUPKP group, n=56） during March, 2009 to February, 2013 were retrospective analyzed. The data were analyzed and compared including those peri-operative and 6 months of followed-up. Results The average age, disease course and prostate volume of the two groups were （73.05±7.05） years old, （87.41±106.54） months and （100.04±12.42） ml in the PEKP group, versus （71.88±6.54） years old, （84.36±102.59） months and （96.78±14.59） ml in the TUPKP group respectively. There was no significant difference in the two groups in these data （P 〉 0.05）. The average operation time was （93.7±27.5） rain and （89.8±22.4） rain. There was with no significant difference between the two groups （P 〉 0.05）. The average weight and the proportion of prostate tissue reseeted, the duration of continuous bladder irrigation and catheterization, time in hospital stay were （64.2±22.1）g, （64.17± 10.15）%, （20.7±6.5）h, （4.3 ±1.5）d and （5.2±1.4）d in the PEKP group, versus （52.7±28.6）g, （54.45 ±9.62）%, （29.6±8.3）h, （5.6±2.1）d and （6.5±1.9）d in the TUPKP group （P 〈 0.05）. Complications occurred in 3 cases of the PKEP group, as compared with 9 cases in the TUPKP group （P 〈 0.05）. There were significant differences between the preoperative and 3-month in postoperative RUV, Qmax, I-PSS, and QOL in each group （P 〈 0.01）. But no remarkable differences were found in preoperative and 3-month postoperative RUV, Qmax, I -PSS, and QOL between the two groups （P 〉 0.05）. Conclusion The short-term efficacy, operation duration and safety of bipolar transurethral plasma kinetic enucleation of prostate for massive benign prostatic hyperplasia are similar to transurethral bipolar plasma kinetic prostatectomy. But the former approach can produce a more radical prostatic resection, and it is beneficial to postoperative recovery.