小前列腺增生引起膀胱出口梗阻两种术式疗效分析

Comparative evaluation of open surgery and transurethral management for bladder outlet obstruction caused by benign prostatic hyperplasia of small volume

目的 比较和评价小前列腺增生所致膀胱出口梗阻开放性前列腺切除术和经尿道切除前列腺加膀胱颈内切开术 (TURP +TUIBN)的治疗效果。 方法 1993年 5月至 2 0 0 2年 6月 ,经耻骨上行前列腺摘除术 2 2例 ,TURP加TUIBN 2 8例。开放组患者平均年龄 6 5岁 ,平均病程 6 5个月 ,术前前列腺平均重量 2 8g ,手术切除前列腺平均重量 7g;TURP加TUIBN组患者平均年龄 6 7岁 ,平均病程6 0个月 ,术前前列腺平均重量 2 5g ,手术切除前列腺平均重量 8.6g。两组患者上述指标及术后随访时间比较 ,差异均无显著性意义 (P均 >0 .0 5 )。两组手术均由同 1名医师操作完成。对比研究两组国际前列腺症状评分 (IPSS)、最大尿流率 (Qmax)、剩余尿量 (PVR)及术后平均住院天数。 结果 开放组IPSS由术前 (2 4 .6± 3.8)分降至术后 (15 .2± 3.4 )分 ,Qmax由术前 (8.3± 2 .9)ml/s升至术后 (9.5± 3.6 )ml/s,PVR由术前 (2 2 0± 30 )ml降至术后 (90± 2 0 )ml,术后平均住院 14 .2d。TURP加TUIBN组IPSS由术前 (2 4 .9± 4 .2 )分降至术后 (5 .8± 2 .7)分 ,Qmax由术前 (8.0± 3.1)ml/s升至术后 (2 3.2± 3.8)ml/s,PVR由术前 (2 30± 2 8)ml降至术后 (15± 4 )ml,术后平均住院 8.5d。比较两组IPSS、Qmax。

Objective To evaluate open surgery vs transurethral management for bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH) of small volume. Methods From May 1993 to June 2002,50 patients were surgically treated.Of them 22 underwent open surgery and 28 underwent TURP plus transurethral incision of bladder neck(TUIBN).There was no statistically significant difference between the 2 groups in age,disease course,preoperative prostate weight and the excised prostate weight.All the surgical procedures were conducted by the same urologist.The efficacy of open surgery and TURP plus TUIBN was comparatively evaluated by IPSS,Qmax and post void residual urine volume(PVR) and hospitalization days. Results The IPSS of those undergoing open surgery decreased from 24.6±3.8 of preoperation to 15.2±3.4 of postoperation ,and the Qmax increased from (8.3±2.9)ml/s to (9.5±3.6)ml/s,and the PVR decreased from(220.0±30.0)ml to(90.0±20.0)ml,and the postoperative hospital stay was 14.2 days.The IPSS of the patients undergoing TURP plus TUIBN decreased from 24.9±4.2 to 5.8±2.7,and the Qmax increased from (8.0±3.1)ml/s to (23.2± 3.8)ml/s,and the PVR decreased from(230.0±28.0)ml to(15.0±4.0)ml,and the postoperative hospital stay was 8.5 days.The postoperative improvement was much greater in the patients undergoing TURP plus TUIBN than those undergoing open surgery as assessed by IPSS,Qmax and PVR (all P<0.001),and hospital stay (P<0.05). Conclusions It is suggested that TURP plus TUIBN is superior to open surgery in treatment of patients with BOO caused by BPH of small volume.TURP plus TUIBN causes less trauma and discomfort. The patients can recovery sooner.So,it is an optimal treatment choice.