经尿道等离子体双极电切术联合腔内剜除法治疗前列腺增生

Transurethral plasmakinetic resection of the prostate and intraluminal enucleation in treatment of benign prostatic hyperplasia

目的 探讨经尿道等离子体双极电切术（PKRP）联合腔内剜除法治疗良性前列腺增生（BPH）的临床疗效。方法 采用经尿道PKRP联合腔内剜除法治疗BPH58例，按ROUS标准：前列腺肿大Ⅱ度20例、Ⅲ度25例、Ⅳ度13例；前列腺质量40～90g，平均50g。观察手术时间、术中出血量、术后留置导尿管时间、手术并发症以及术前、术后国际前列腺症状评分（IPSS）、生活质量评分（QOL）、剩余尿量、最大尿流率的差异。结果 手术时间加～120min，平均80min；术中出血量60～180ml，平均90ml。未发生电切综合征和膀胱穿孔等并发症。术后留置导尿管3～5d，平均住院时间5d。全部患者随访6—18个月，IPSS由（28．5±3．0）分下降至（8．0±4．0）分，QOL由（5．0±0．5）分下降至（1．5±0．5）分，剩余尿量由（80±25）ml减少至（20±5）ml，最大尿流率由（7．0±2．5）mL／s上升至（25．0±2．5）mL／s。结论 经尿道PKRP治疗BPH，具有安全、并发症少、近期疗效确切等优点。

Objective To evaluate the clinical efficacy of the transurethral plasmakinetic resection of the prostate （PKRP） and intraluminal enucleation in treatment of benign prostatic hyperplasia （BPH）. Methods Fifty eight cases of benign prostatic hyperplasia treated with PKRP and intraluminal enucleation were reviewed retrospectively. The operation time, the surgery blood loss, transurethal resection syndrome （TURS） occurring, catherization time, hospital stay, the difference of IPSS and quality of life （QOL） were observed. Results According to ROUS standard, there were BPH grade Ⅱ in 20, grade Ⅲ in 25, grade Ⅳ in 13. Prostate mass was range from 40 to 90 g, average 50 g. Operation time was range from 40 to 120 minutes, average 80 minutes. Surgery blood loss was range from 60 to 180 ml, average 90 ml. There were no TURS and bladder rupture occurred. The catheter was maintained for 3 - 5 days postoperatively. The average hospital stay was 5 days. All cases were followed up from 6 to 18 months. The IPSS decreased from （28.5 ± 3.0） to （8.0 ± 4.0） and the QOL decreased from （5.0 ± 0.5 ） to （ 1.5 ± 0.5 ）. Residual urine volume decreased from （80 ± 25 ） ml to （20 ± 5 ） ml and peak urine flow（Qmax） increased from （7.0 ±2.5）ml/s to （25.0 ±2.5）ml/s. Conclusions Transurethral PKRP in treatment of benign prostatic hyperplasia has advantages of high safety, less complication and satisfactory efficacy.