经尿道手术治疗小体积良性前列腺增生的术式分析

Analysis of surgical transurethral treatment for small-size benign prostatic hyperplasia

目的探讨经尿道手术治疗小体积良性前列腺增生(BPH)的手术方式,以提高手术疗效。方法总结经尿道手术治疗小体积BPH52例的临床资料,手术方式有3种,12例单纯行经尿道前列腺电切术(TURP),为单纯TURP组;18例行TURP+经尿道膀胱颈切开术(TUIBN),为TURP+TUIBN组;22例行TURP+经尿道膀胱颈电切术(TURBN),为TURP+TURBN组。以国际前列腺症状评分(IPSS)、最大尿流率(MFR)、残余尿(PVR)对3组不同手术方式的疗效进行比较分析。结果单纯TURP组:术后有3例并发膀胱颈挛缩,术后IPSS为(12.2±3.2)分,MFR为(11.7±2.6)ml/s,PVR为(27.6±13.0)ml。TURP+TUIBN组:术后1例并发膀胱颈挛缩,术后IPSS为(8.6±3.2)分,MFR为(16.7±3.0)ml/s,PVR为(20.0±8.0)ml。TURP+TURBN组:术后IPSS为(6.2±3.0)分,MFR为(22.7±3.1)ml/s,PVR为(8.0±4.0)ml。3组比较,术前IPSS、MFR、PVR各组间差异无统计学意义(P>0.05),而术后IPSS、MFR、PVR各组间差异有统计学意义(P<0.01)。TURP+TUIBN组疗效优于单纯TURP组,TURP+TURBN组疗效最佳。结论经尿道手术治疗小体积BPH,TURP+TURBN疗效比TURP+TUIBN疗效更确切,应作为首选术式。手术的关键是既要切除增生的腺体,又要彻底切除膀胱颈部的病变组织。

Objective To investigate the surgical methods of transurethral treatment for small-size benign prostatic hyperplasia （BPH） in order to improve the curative effect. Methods The clinical data of 5：2 cases of small-size BPH treated by transurethral operation were analyzed. Transurethral prostate resection （TURP） was underwent in 12, TURP plus transurethral incision of bladder neck（TUIBN） in 18, TUPR plus transurethral resection of bladder neck （TURBN） in 22. According to the International Prostate Symptom Score （IPSS）, maximum flow rate （MFR） and post void residual urine volume （PVR） , the curative effects were evaluated. Results In TURP group, the complication of bladder neck contracture occurred in 3 postoperatively. IPSS, MFR and PVR were 12.2±3.2, （ 11.7 ±2.6） ml/s, （27.6±13.0） ml, respectively. In TURP ＋ TUIBN group, bladder neck contracture occurred in 1, and IPSS, MFR and PVR were 8.6 ±3.2, （ 16.7±3.0）ml/s, （20.0 ±8.0）ml,respcctively, while in TURP ＋ TURBN group, they were 6.2 ±3.0, （22.7± 3. 1 ） ml/s, （8.0 ± 4.0） ml ,respectively. There were no significant differences in these parameters （IPSS, MFR, PVR） among three groups before the operation （P 〉0.05）, but there were significant differences after the operation （P 〈 0.01 ）. The curative effect in TUR.P ＋ TUIBN group was better than that of TURP group, but TURP ＋ TURBN group was the best. Concluslons Treatment of small size BPH by transurethral operation, TURP ＋ TURBN is more effective than that of TURP ＋ TUIBN, which should be the first surgical selection. The key of operation is to resect not only the hyperplastic gland but also the pathological changes of bladder neck thoroughly.