腔内剜除法在经尿道前列腺汽化电切术中的应用

Intraluminalenucleation in transurethral vaporization and electro-resection of the prostate

目的评价腔内剜除法在经尿道前列腺汽化电切除术(TUVP)中的应用价值.方法在前列腺双极汽化电切术中结合镜鞘及电切袢的应用,于前列腺尖部寻找到增生腺体和外科包膜的界面,沿此间隙将增生腺体从外科包膜上环状剥离、剜除,切碎.通过临床1000例应用研究,对术中出血量、手术时间、安全性及术后出血时间、出血量及拔除尿管时间和预后效果进行观察分析.结果采用新的切割方法前列腺尖部被完整剜除,无需修整,尖部尿道成为由外科包膜构成的喇叭口状自然界面,经过剜除的增生腺体,界面清楚,血供减少,利于快速切除,不易出现包膜损伤,切除效率明显提高.1000例手术顺利,术后发生短期尿道刺激症者150例,发生膀胱颈挛缩6例,尿道狭窄10例.手术时间、出血量随着前列腺体积和重量的增加而相应延长或增加,与前列腺体积、重量呈正相关(P＜0.05).随访6～18个月,无死亡病例,无再次手术及永久性尿失禁等并发症发生.结论腔内剜除术是TUVP术中一种切实可行的新技术,值得临床应用与推广.

Objective To introduce and evaluate a new procedure,intraluminal enucleation,during transurethral vaporization and electro-resection of the prostate （TUVP）. Methods During the process of intraluminal enucleation of the prostate with bipolar PK generation, the tube and wire loop attachment of the resectoscope were used to find out the latent division between gland lining and the surgical envelope of the prostate. According to the division the whole central part of the prostate was removed from surgical envelope and chipped. Based on the data of 1000 cases, the intraoperative blood loss volume, operating time, safety and postoperative bleeding, catheterization time and prognosis were evaluated. Results With the new procedure, the tip of the prostate was peeled off completely without extra treatment, and this piece of the urethra,which was composed of surgical envelope, formed a vase-shaped natural surface to avoid urine irretention. The resected plane was covered by fibre and epithelium of surgical envelope,which could reduce irritation of urethra and bladder, and shorten hematuria and repair time. After enucleation of the enlarged prostate, the borderline became clear and blood supply was reduced, which facilitated the rapid resection without injury. Of the 1000 cases who underwent the procedure uneventfully, 150 had short-term irritation of the urethra, 6 had bladder neck contracture and 10 had urethral stricture. The operating time and blood loss volume were increased with the increase in the prostate volume and weight, showing an obviously positive correlation （P 〈 0.05 ）. During a follow-up for 6- 18 months, there were no death, re-operation and permanent urinary incontinence in these cases. Conclusions Intraluminal enucleation during TUVP is a new and feasible procedure for BPH, which should be popularized in clinical practice.