大体积前列腺经尿道双极等离子体切除方法比较（附105例报告）

The methods of transurethral bipolar plasmakinetic prostatectomy for benign prostatic hyperplasia with large volume ：report of 105 cases

目的探讨大体积前列腺经尿道双极等离子体切除方法的有效性及安全性。方法回顾性分析经尿道双极等离子体切除大体积前列腺105例患者的临床资料。采用顺行切割（Nesbit法组，45例）和经尿道分割、逆行撬剥切割（分割、撬剥切割法组，60例）两种不同切割方法，比较两组手术时间、术中及术后出血量、术后持续膀胱冲洗时间等指标。结果Nesbit法组平均切除腺体组织效率（0．79±0．17）g／rain、平均切除腺体组织出血量（3．87±1．09）ml／g、术后24hHb下降（6．84±3．96）g／L、术后平均持续膀胱冲洗时间72h、输血8例；分割、撬剥切割法组分别为（1．16±0．20）g／rain、（1．60±0.64）ml／g、（3．87±2．33）g／L、36h、无一例输血。两组比较差异均有统计学意义（P〈0．05）。结论对于大体积前列腺采用分割、逆行撬剥切割法经尿道双极等离子体切除，与Nesbit法比较具有出血量少、手术时间短、冲洗液用量少、切除腺体彻底、安全性高，并可规范手术操作、便于教学推广等优点。

Objective To study the effectiveness and safety of methods of transurethral bipolar plasmakinetic prostatectomy for benign prostatic hyperplasia with large volume. Methods The transurethral bipolar plasmakinetic prostatectomy with Nesbit （Nesbit group, 45 cases）and prying - up technique （prying-up group, 60 cases ）were performed in 105 patients of the prostatic volume of more. than 60 g. The results could be obtained by comparing operative time, intraoperative and postoperative blood loss and the time of postoperative sustained washing of the bladder between the two groups. Results In Nesbit group, the effi- ciency of average cutting gland was （0.79 ± 0.17）g/min,the average intraoperative blood loss was （3.87± 1.09 ）ml/g, the decrease in postoperative Hb within 24 hours was （6.84 ± 3.96 ）g/L, the average time of postoperative continuous washing of the bladder was 72 hours, 8 patients were given by blood transfusion. In prying-up group , the corresponding data were （ 1.16 ± 0.20） g/min, （ 1.60 ±0.64） ml/g, （3.87 ± 2.33 ）g/L, 36 hours respectively, none of patients was given by blood transfusion. There were statistically significant in two groups（P 〈 0.05 ）. Conclusions The adoption of prying-up is more favorable compared with Nesbit method in the aspects such as less blood loss, shorter operating time, less lotion, more thorough resection of the gland, higher security. It is conducive to delivering lecture, and it enables the standard operational procedure available.