经尿道手术治疗良性前列腺增生三种术式的疗效比较

Clinical efficacy evaluation of three means of transurethral operation for benign prostatic hypertrophy

目的比较经尿道电切（TURP）、经尿道汽化电切（TUVP）、经尿道等离子切割（PKRP）3种手术方法治疗良性前列腺增生（BPH）的疗效及并发症。方法分别采用TURP、TUVP、PKRP3种方式治疗BPH患者54,5例。TURP组230例，年龄51～87岁（平均73岁），前列腺重量20～138g（平均50g）；TUVP组250例，年龄49～92岁（平均73岁），前列腺重量22～143g（平均53g）；PKRP组65例，年龄51～89岁（平均72岁），前列腺重量25～127g（平均52g）。3组病例术前前列腺症状评分（IPSS）、剩余尿量（RUV）、最大尿流率（Qmax）、生活质量评分（QOL）比较差异均无统计学意义（P〉0．05），比较3组手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率及疗效。结果TURP组成功228例（99％）；TUVP组成功245例（98％）；PKRP组65例均获成功。TURP、TUVP、PKRP组手术时间分别为38（15～90）、41（25～120）、38（17～120）min。组间比较差异无统计学意义（P〉0．05）；3组术中出血量分别为79（32～310）、75（43～920）、44（25～156）ml，组间比较差异有统计学意义（P〈0．01）；3组术后平均留置尿管时问分别为4．1、4．2、3．5d（P〉O．05）；3组平均住院时间分别为6．2、6．7、5．1d（P〈0．01）。TURP组发生尿道口狭窄1例、TURS2例、尿外渗3例，并发症发生率2．6％。TUVP组并发尿道口狭窄7例、后尿道狭窄2例、术中术后出血3例、尿外渗1例、轻度尿失禁1例、附睾炎3例，并发症发生率6．8％。PKRP组术后并发尿外渗2例，并发症发生率3．1％。术后3、6个月随访，3组IPSS、RUV、QOL均较术前明显下降，qmax均较术前明显增加，但组间比较差异均无统计学意义（P〉0．05）。结论3种方法均有明确的临床效果，临床上可根据患者情况和适应证选择不同方法，以获得更好的临床疗效。

Objective To compare the clinical efficacy and complications of transurethral resection of the prostate （TURP）, transurethral vapor-resection of the prostate （TUVP） and plasmakinetic energy transurethral resection of the prostate （PKRP） for benign prostatic hypertrophy （BPH）. Methods A total of 545 patients with BPH were enrolled from December 1999 to January 2004. Of them, 230 cases aged 51--87 years （mean, 73 years） with prostate weight of 20--138 g （mean, 50 g） underwent TURP; 250 cases aged 49--92 years （mean, 73 years） with prostate weight of 22--143 g （mean, 53 g） underwent TUVP; 65 cases aged 51--89 years （mean, 72 years） with prostate weight of 25--127g （mean, 52 g） underwent PKRP. Before operation there was no significant difference in the IPSS, residual urine volume （RUV）, Qmax and QOL among the 3 groups （P〉0.05）. The operative time, blood loss, catheterization time, hospital stay and complications were compared among the 3 groups. Results In TURP, TUVP and PKRP groups, the relevant parameters were as follows.The operation success rates were 99% （228/230）, 98% （245/250） and 100% （65/65）, respectively. The mean operative time was 38 min （range, 15--90 min）, 41 min （25--120 min）, 38 min （17--120 min）, respectively （P〉0.05）. The mean blood loss during operation was 79 ml （32--310 ml）, 75 ml （43-920 ml） and 44 ml （25--156 ml）, respectively （P〈0.01）. The mean catheterization time was 4.1 d, 4.2 d and 3.5 d, respectively （P〉0.05）. The mean hospital stay was 6.2 d, 6.7 d and 5.1 d, respectively （P〈0.01）. In TURP group, meatus urinarius stenosis occurred in 1 ease, transurethral resection syndrome （TURS） in 2, and urinary exudation in 3, with a complication rate of 2.6%. In TUVP group, meatus urinarius stenosis occurred in 7 cases, posterior urethrostenosis in 2, urinary exudation in 1, bleeding in 3, mild incontinence in 1 and epididymitis in 3, with a complication rate of 6.8%. In PKRP group, urinary exudation occurred in 2 cases, with a complication rate of 3. 1%. Postoperatively, follow-up at 3 and 6 months showed obvious decrease in IPSS, RUV, QOL scores, and increase in Qmax scores, but with no significant difference among the 3 groups （P〉0. 05）. Conclusions All the 3 surgical procedures have significant efficacy in the treatment of BPH, but have respective superiorities over the others. These surgical modalities can be chosen based on individual conditions and circumstance of the prostate so as to obtain better clinical results.