经尿道等离子双极电切治疗良性前列腺增生600例报告

Transurethral resection of hyperplastic prostate with bipolar plasmakinetic technique

目的 探讨经尿道前列腺等离子双极电切的安全性与有效性。方法 自2001年4月至2003年10月采用经尿道等离子 双极电切行前列腺切除(PKRP)600例。患者年龄51～93岁,平均70.8岁;前列腺大小21～186g,平均(49.6±38.2)g。术后随 访1～12个月。结果 PKRP平均手术时间(49±37)min(13～131min),切除前列腺组织重量平均(32±29)g(7～130g),无1 例需输血,无经尿道电切综合征发生。术后1、3、6、12个月,最大尿流率(Qmax)由术前的(5.1±3.9)mL/s分别上升至(19.4± 4.1)、(22.8±4.6)、(21.6±5.8)、(22.1±6.3)mL/s;国际前列腺症状评分(IPSS)由术前的24.6分别下降至6.8、5.6、5.2、5.2; 生活质量评分(QOL)由术前的5.3分别下降至1.8、1.9、1.3、1.3。3项指标手术前后比较均有显著性差别(P均<0.05)。 结论 等离子双极电切行经尿道前列腺切除是一种安全、有效的手术方式。其包膜切除效率虽低,但仍有切穿包膜的危险。

Objective To assess the efficacy and safety of transurethral resection of prostate (PKRP) with plasmakinetic energy. Methods 600 patients(mean age 70.8 years; range from 51 to 93 ) with symptomatic BPH but without suspected cancer (confirmed by IPSS, urinary flow rate, ultrasonographic estimate and PSA tests) were treated by PKRP. All patients were followed up for 1～12 months postoperatively. Results For PKRP, the duration of the procedure was (49±37) min( range 13 to 130min ). No case needed blood transfusion during the operation. No transurethral resection syndrom occurred. The mean catheterization time was 2 days (1 to 4 days). The peak flow rate increased from 5.1±3.9mL/s to 19.4± 4.1, 22.8± 4.6, 21.6±5.8, 22.1±6.3mL/s at 1, 3, 6 and 12 months respectively. The IPSS decreased from 24.7 to 6.8, 5.6, 5.2, 5.2; and the QOL decreased from 5.3 to 1.8, 1.9, 1.3, 1.3 at 1, 3, 6 and 12 months respectively. No adductor reflex was found in all the patients (P< 0.05). Conclusion It is suggested that transurethral bipolar plasmakinetic resection of prostate is effective and safe. This pilot series permits a comparative study with conventional TUR.