腔内手术与开放手术治疗前列腺增生的疗效比较

Endoscopic surgery versus prostatectomy for benign prostatic hyperplasia

目的 :探讨经尿道腔内手术及传统开放手术治疗前列腺增生症 (BPH)的彻底性 ,对比不同方法的疗效。方法 :将BPH患者 1 2 6例 ,随机分成腔内组和开放组。测量切除腺体重量及术前B超估计重量 ,求得腺体切除率。术后 3个月随访 ,根据IPSS评分、最大尿流率、并发症和住院时间等 ,比较两类术式的疗效。结果 :腔内组95例 ,平均切除腺体 (2 5 .8± 1 6 .7) g ,平均腺体切除率6 1 .4 % ;开放手术组 31例 ,平均切除 (39.6± 30 .8) g ,平均腺体切除率 70 .8% ;手术疗效二组间差异无显著性意义 (P >0 .0 5 )。而术后住院时间等 ,腔内组明显短于开放组 (P <0 .0 5 )。结论 :腔内手术近期疗效与开放手术类似 ,效果好 ,并发症少 ,但对增生腺体切除率偏低 ,可能影响远期疗效。等离子双极汽化前列腺切除术采用腔内分隔切开逆行剥离法切除增生腺体 ,有望达到开放手术顺行剥离切除腺体的效果。

Purpose:To compare the clinical effect of different surgical methods for benign prostatic hyperplasia,including endoscopic surgery and open prostatectomy.Methods:126 patients with BPH were randomized into two groups to receive endoscopic surgery and prostatectomy. The weights of prostates were estimated by B mode ultrasound before operation. The weight of the prostate tissues resected and resection rate were recorded. Various parameters such as IPSS score, peak urinary flow rate, hospital stay were analyzed.Results:In 95 cases treated by endoscopic surgery the mean weight of tissues resected was ( 25.8 ± 16.7 ) g and the proportion of resection was 61.4 %. In 21 cases treated by open prostatectomy the mean weight of tissues resected was ( 39.6 ± 30.8 ) g and the proportion of resection was 70.8 %. There was no significant differences in respect of the weight of the prostate tissues resected and resection rate between these two groups(P> 0.2 ). The postoperative hospital stay was significiantly shorter in the endoscopic group than that in the open surgical group(P<0.05).Conclusions:Endoscopic surgery for BPH had similar recent effect as classical operation and less complications. However, the tissue proportion of endoscopic resection was lower than that of surgical resection,which may cast unfavorable influence over the long term effect. The newly developed retrograde enucleation method by PKV P is expected to achieve the same optional effect as prostatectomy.