经尿道手术治疗小体积前列腺增生术式比较

Comparison of Transurethral Surgical Methods for Treating Small-size Prostate 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,12例单纯经尿道前列腺电切(TURP),18例TURP加经尿道膀胱颈切开术(TUIBN),22例TURP加经尿道膀胱颈电切术(TURBN)。以国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、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例并发膀胱颈孪缩,术后IPSS为(12.2±3.2)分,Qmax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,Qmax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,Qmax为(22.7±3.1)ml/s,PVR为(8.0±4.0)ml。3种术式比较,术前IP-SS、Qmax、PVR各组间差异无显著性(P>0.05),而术后IPSS、Qmax、PVR各组间差异有显著性(P<0.01)。TURP+TUIBN疗效优于单纯TURP,TURP+TURBN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,也要彻底切除膀胱颈部的病变组织。

Objective： To analyze different transurethral surgical methods for the treatment of small-size benign prostate hyperplasia （BPH） in order to improve the curative effect. Methods ： The clinical data of 52 cases of small-size BPH treated by transurethral surgery ＇were reviewed and analyzed. Of the total number, 12 underwent transurethral prostate resection （TURP）, 18 TURP plus transurethral incision of the bladder neck （TUIBN） and 22 TURP plus transurethral resection of the bladder neck （TURBN）. The curative effect of the three different surgical methods was evaluated by international prostate symptom score （IPSS）, maximum flow rate （Qmax） and post-voiding residual urine volume （PVR）. Results ： In the TURP group, 3 cases were complicated with contracture of the bladder neck, and the IPSS, Qmax and PVR were （ 12.2 ± 3.2）, （ 11.7 ± 2.6） ml/s and （ 27.6 ± 13.0） ml, respectively. In the TURP ＋ TUIBN group, there was only 1 case of the complication and the three indices were respectively （8.6 ± 3.2）, （16.7 ± 3.0） ml/s and （20.0 ± 8.0） ml. No complication was observed in the TURP ＋ TURBN group and the three indices were （6.2 ± 3.0）, （22.7 ±3.1） ml/s and （8.0±4.0） ml, respectively. No statistical difference （P〉0.05） was found in IPSS, Qmax and PVR among the three groups before the operation, but significant difference （ P 〈0.01 ） was observed after it. The curative effect was better in the TURP ＋ TUIBN group than in the TURP, but was the best in the TURP ＋ TURBN. Conclusions： TURP ＋ TURBN, being more effecrive than TURP ＋ TUIBN, should be used as the first option for the surgical treatment of small-size BPH. The key to the operation is to thoroughly remove not only the hyperplastic gland but also the pathological changes of the bladder neck. Natl J Androl,2007,13 （2） ：150-152