经尿道等离子前列腺逆行剥离切除术治疗良性前列腺增生症

Transurethral Retrograde Dissection of the Prostate for Benign Prostatic Hyperplasia

目的探讨经尿道等离子前列腺逆行剥离切除术治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)的效果。方法2005年12月～2007年12月,经尿道等离子前列腺逆行剥离切除术治疗BPH68例。术前B超测量前列腺体积30～120ml,平均75ml;残余尿量(RU)60～250ml,平均89ml;最大尿流率(Qmax)3.5～6.9ml/s,平均5.1ml/s;IPSS评分19.8～23.5分,平均21.6分。结果68例均手术成功,切除的前列腺组织30～120g,其中>60g15例。手术时间35～85min,平均45min。术中失血50～100ml,平均60ml,无输血。无前列腺外科包膜破裂、静脉窦破裂、膀胱前列腺连续部穿孔。68例术后随访4～6个月,Qmax增至16.4～23.2ml/s(平均19.8ml/s),RU降至0～15ml(平均5ml),IPSS评分0～6.8分(平均4.2分),均恢复正常。无尿失禁。结论经尿道等离子前列腺逆行剥离切除术治疗BPH具有手术彻底、出血少、尿失禁发生率低等优点,手术相对简单,易于掌握。

Objective To investigate the efficacy of transurethral retrograde dissection of the prostate in the treatment of benign prostatic hyperplasia（BPH）.Methods Sixty-eight patients with BPH were treated with transurethral retrograde dissection in our hospital from December 2005 to December 2007.Preoperative B-ultrasonography showed that the prostate volume ranged from 30 to 120 ml（mean,75 ml）.The patients had a mean residual urine（RU） of 89 ml（60-250）,mean peak urine flow rate（Qmax） of 5.1 ml/s（3.5-6.9）,and mean IPSS of 21.6（19.8-23.5）.Results The operation was completed in all of the 68 cases.The resected prostate tissues weighed 30 to 120 g（〉60 g in 15 cases）.The operation time ranged from 35 to 85 minutes（mean,45）,and the blood loss was 50-100 ml（mean,60 ml）.No case needed blood transfusion.No rupture of the prostatic capsule,venous sinuses,or perforation of the bladder-prostate junction occurred in this series.The patients were followed up for 4 to 6 months,during which the Qmax increased to 16.4-23.2 ml/s（mean,19.8 ml/s）,RU decreased to 0-15 ml（mean,5 ml）,and IPSS score improved to 0-6.8（mean,4.2）.No patient developed urinary incontinence.Conclusions Transurethral retrograde dissection of the prostate is effective for the treatment of BPH with a low morbidity rate of urinary incontinence.The procedure is simple and results in low blood loss.