三种前列腺切除术的疗效比较

Comparison of curative effects in three methods of prostatectomy

目的 :比较前列腺增生症 (BPH)的三种前列腺切除术的治疗效果。方法 :分别采用耻骨上经膀胱前列腺摘除术 (SPPC) ,Madigan'S前列腺切除术 (MPC)经尿道前列腺汽化电切术 (TUVP) ,治疗前列腺增生症共482例。术前及术后3月对患者进行IPSS评分及最大尿流率测定 ,并对术中出血量、尿管留置时间、住院时间、膀胱冲洗时间、手术并发症等指标进行比较 ,评价三种手术方式的疗效。结果 :三种手术术后患者IPSS评分均明显降低 ,下尿路梗阻症状明显改善 ,最大尿流率增加 ,但改善程度MPC不及SPPC和TUVP。SPPC较MPC和TUVP出血量多 ,住院时间长 ,留置尿管时间长 ,并发症多 ,而MPC和TUVP无明显差异。结论 :TUVP具有出血少 ,痛苦小 ,恢复快 ,住院时间短 ,并发症少等优点 ,适合于各种类型的前列腺增生症患者 ,尤其是高危前列腺增生症患者。而MPC术式对有慢性前列腺炎、前列腺中叶增生明显者 ,曾经行电切术或射频、微波治疗者不宜采用 ,TUVP与MPC疗效相当 ,优于SPPC。

Objecitve:To compare the curative effects of three methods of prostatectomy for treating benign prostatic hyperplason(BPH).Methods:Suprapubic per bladder prostatectomy(SPPC).Madigan's prostatectomy(MPC)and transuretral vaporization electro-prostatectomy(TUVP)were used respectively in482cases with BPH.Before and3months after operation.IPSS score and the maximum flowrate determination were performed,and the comparison of intraoperative bleeding volume,indwelling catheter time,hospitalization time,irrigation of bladder time,opˉerative complication and so on in three groups was also performed.The curative effects of three modes of operation were evaluated.Results:IPSS score in these patients with BPH after three methods of operation was obviously decreased,the symptom of lower urethra obstruction was markedly improved,the maximum flowrate was increased,but the improvement degree in MPC was not as good as that in SPPC and TUVP.The bleeding volume and operative complication in SPPC were much more,and the time of hospitalization and indwelling catheter was more long compared with those in MPC and TUVP,but the difference between MPC and TUVP was not significant.Conclusion:All three modes of operation are much efˉ fective for treating BPH,but each has his own strong points.TUVP is suited to all types of BPH,especially for the patients with high risk BPH,with less bleeding,less complication,little pain,fast recovery and so on.MPC is not suitable to be applied to chronic prostatitis and hyperplasia of prostatic lobe treated previously by electrocision,radio-frequency or microwave therapy.The curative effect in TUVP is identical to that in MPC,both TUVP and MPC are superior to SPPC.