膀胱肿瘤合并前列腺增生症同期等离子电切治疗(附41例报告)

Transurethral Plasmakinetic Resection for Bladder Tumor Complicated with BPH:Report of 41 Cases

目的探讨同期经尿道等离子电切治疗浅表膀胱肿瘤(superficial bladder tumor,SBT)合并前列腺增生症(benign prostate hyperplasia,BPH)的安全性和有效性。方法根据膀胱肿瘤的位置、大小、数目和前列腺大小、腺体与包膜粘连情况等,采用不同的等离子电切方法同期治疗41例SBT合并BPH,术后膀胱灌注化疗。结果41例手术顺利。PKRBt手术时间(67·2±25·3)min,PKRP时间手术时间(72·3±23·2)min。术中闭孔神经反射7例,膀胱穿孔2例,无电切综合征、直肠穿孔,未发生死亡病例。术后6个月国际前列腺症状评分(IPSS)为(6·2±3·7)分、最大尿流率(Qmax)为(20·1±4·2)ml/s,与术前(25·3±4·1)分、(8·9±4·1)ml/s相比明显改善(t=22·209,P=0·000;t=-12·174,P=0·000)。41例术后随访1～4年,平均9例肿瘤复发。结论选择合适的SBT病例并根据前列腺增生情况,灵活采用不同的等离子电切方法同期治疗SBT合并BPH是一种安全有效的手术策略。

Objective To evaluate the efficacy and safety of transurethral plasmakinetic resection for patients with superficial bladder tumor （SBT） complicated with benign prostate hyperplasia （BPH）. Methods A total of 41 patients with SBT complicated with BPH were treated by transurethral plasmakinetic resection in our hospital. Various procedures were selected basing on the location, size, quantity of the bladder tumors, size of the prostate, and degree of adhesion around the gland. Results The opertion was completed in all of the 41 cases. The mean operation time was （67.2 ± 25.3 ） rain for resection of the bladder tumors and （72.3 ±23.2） rain for the prostate. During the surgery,7 cases showed obturator nerve reflex and 2 developed bladder perforation, No patients died or had transurethral resection syndrome or rectal perforation. Six months after the operation, reexamination showed a mean IPSS of 6.2 ± 3.7 and Qmax, of （20. 1 ± 4.2） ml/s, which were significantly imporved compared with those detected before the surgery [ 25.3 ± 4. 1, （8.9 ± 4. 1 ） ml/s, t = 22. 209 and - 12. 174 respectively; and both P = 0. 000 ]. The patients were followed up for 1 to 4 years, during which 9 cases showed recurent bladder tumor. Conclusions Transurethral plasmakinetic resection is safe and effective for patients with SBT complicated with BPH. The surgical procedure should be determined accordingly.