经尿道等离子前列腺剜除术与经尿道前列腺电切术治疗重度良性前列腺增生症的疗效及安全性比较

Comparative analysis of clinical efficacy and safety of transurethral resection of prostate and bipolar plasmakinetic enucleation of prostate in the treatment of benign prostatic hyperplasia

目的探讨比较经尿道等离子前列腺剜除术（PKEP）与经尿道前列腺电切术（TURP）对重度良性前列腺增生（BPH）的疗效及安全性。方法收治BPH患者随机分为PKEP和TURP组，分别比较两组患者手术时间（OT）、术中出血（BL）、腺体切除质量（RTW）、腺体切除率（GRR），术后尿管留置时间（IUT）、膀胱造瘘管留置时间（BFUT）、住院时间（HST），以及术前术后血钠浓度（SSC）、前列腺质量（Pw）、血红蛋白浓度（HGB）、残余尿（RUV）、最大尿流率（Qmax）、勃起功能国际问卷（IIEF-5）、生活质量（QOL）、国际前列腺评分（IPSS）和主要并发症。结果两组间OT、BL、IUT、BFUT、HST、RTW、GRR、PW差值、HGB差值、SSC差值及术后PW、HGB、SSC有明显差异（P〈0．01）。PKEP组患者膀胱痉挛、暂时性尿失禁、逆行射精、膀胱颈挛缩或尿道狭窄发生率明显低于TURP组（P〈0．01），PKEP组闭孔神经反射、包膜穿孔、输血、继发性出血、ED发生率稍低于TURP组（P〈0．05）。两组间术后IIEF-5及IIEF-5差值有明显差异（P〈0．01）。两组术后IPSS、QOL、Qmax、RUV与术前比较差异有统计学意义（P〈0．01），但两组间术前、术后及其差值比较均无明显差异（P〉0．05）。结论与TURP相比，PKEP对重度BPH具有相同的满意疗效，同时具备出血少、时间短、切除彻底及并发症少等优点，是治疗BPH有效、安全的方法。

Objective To evaluate the clinical efficacy and safety of plasmakinetic enucleation of prostate （PKEP） and transurethral resection of prostate （TURP） in the treatment of massive benign prostatic hyperplasia （BPH）. Methods BPH patients were randomly divided into PKEP and TURP group. The operation time （OT）, intraoperative blood loss （BL）, resected tissue weight （RTW）, gland resection ratio （GRR）, the time of postoperative indwelling ureter, bladder fistula ureter and hospital stay （IUT, BFUT, HST）, preoperative and postoperative serum sodium concentration （SSC）, prostateweight （PW）, HGB, residual urine （RUV）, maximum urinary flow rate （Qmax）, international questionnaire of erectile function （IIEF-5）, quality of life （QOL）, international prostate score （IPSS）, and major complication were comparatively analyzed. Results There were significant differences in OT, BL, IUT, BFUT, HST, RTW, GRR, PW difference value （DV）, HGB DV, SSC DV, postoperative PW, postoperative HGB, and postoperative SSC between the two groups （P〈0.01）. Bladder spasm, transient urinary incontinence, retrograde ejaculation, bladder neck contracture or urethral stricture incidence in PKEP group was significantly lower than that in TURP group （P〈0.01）. Obturator nerve reflex, capsule perforation, blood transfusion, secondary hemorrhage and ED incidence in PKEP group was lower than that in TURP group （P〈0.05）. There were significant differences in postoperative IIEF-5, IIEF-5 DV between the two groups （P〈0.01）. There were significant differences in IPSS, QOL, Qmax, RUV between postoperative and preoperative value （P〈0.01）. There were no statistical differences in postoperative and preoperative IPSS, QOL, Qmax, RUV, the DV between the two groups （P〉0.05）. Conclusion PKEP and TURP have similar clinical efficacy in the treatment of massive BPH. PKEP shows great advantages over TURP in shorter OT, less BL, more GRR and fewer complications, but long-term therapeutic effect of PKEP needs further investigationKey words Benign prostatichyperplasia （BPH）; Bipolar plasmakinetic enucleation of the prostate （PKEP）; Transurethral resection of prostate （TURP）; Transurethral resection syndrome; Residual urine volume （RUV）.