经尿道前列腺等离子剜除术与电切术治疗前列腺增生的疗效比较

Comparison of therapeutic effects between transurethral plasma kinetic enucleation of prostate and transurethral resection of prostate on benign prostatic hyperplasia

目的比较经尿道前列腺等离子双极电切剜除术（TUPKEP）与经尿道前列腺电切术（TURP）治疗良性前列腺增生（BPH）的临床疗效及安全性。方法将142例BPH患者分为两组，TUPKEP组72例，年龄52～90岁，平均（70．5±7．6）岁，前列腺质量27～126g，平均（75．6±10．3）g；TURP组70例，年龄51～87岁，平均（70．2±6．8）岁，前列腺质量25～118g，平均（73．8±9．9）g。两组患者术前年龄、前列腺质量、前列腺症状评分（IPSS）、剩余尿量、最大尿流率、生活质量评分（QOL）比较，差异均无统计学意义（t值分别为0．2873、1．0612、1．0832、0．9522、0．0000、1．0774；P值分别为0．7743、0．2904、0．2806、0．3426、1．0000、0．2832）。比较两组手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率及疗效。结果TUPKEP组72例均获成功（100．0％），TURP组成功69例（98．6％）。TUPKEP、TURP组平均手术时间分别为（46.2±6.4）min、（58．4±9．6）min，组间比较差异有统计学意义（t=8．9404，P=0．0000）；两组术中出血量分别为（105．9±12．2）ml、（148．6±14．3）ml，组间比较差异有统计学意义（t=19．1608，P=0．0000）；两组术后平均留置尿管时间分别为（3．5±1．0）d、（5．0±1．0）d（t=8．9364，P=0．0000）；两组术后平均住院时间分别为（5．1±1．9）d、（7.0±2.6）d（t=4．9819，P=0．0000）。TUPKEP组术后发生暂时性尿失禁1例，继发前列腺出血2例，尿道外口狭窄1例，并发症发生率5．56％；TURP组发生经尿道前列腺电切综合征2例，尿外渗1例，术后暂时性尿失禁2例，继发前列腺出血3例，尿道外口狭窄2例，并发症发生率14．29％。术后随访3个月，两组最大尿流率较术前明显增加，IPSS、剩余尿量、QOL均较术前明显下降，组间比较差异均无统计学意义（t值分别为1．1131、0．2543、1．2959、0．7252；P值分别为0．2676，0．7996、0．1971、0．4696）。结论TUPKEP与TURP治疗BPH的疗效相近，但TUPKEP平均手术时间短、术中出血量少、围手术期及术后并发症发生率低，手术安全性更高。

Objective To compare the clinical efficacy and safety between transurethral plasma kinetic enucleation of prostate（TUPKEP） and transurethral resection of prostate（TURP） on benign prostatic byperplasia（BPH）. Methods One hundred and forty two BPH patients were divided into two groups：TUPKEP group （72 cases） and TURP group （70 cases）. Seventy two cases aged 52-90 years[mean age （70.5±7.6） years] with prostate weight of 27-126 g [mean weight （75.6±10.3）g] underwent TUPKEP, and seventy cases aged 51-87 years[mean age （70.2±6.8） years] with prostate weight of 25-118 g [mean weight （73.8 ±9.9）g] underwent TURP. There were no significant differences in age, weight of the prostate, international prostate symptom score（IPSS）, residual urine volume（RUV） ,maximum urinary flow rate （Qmax） and quality of life （OOL） scores between the two groups before operation （t = 0. 2873,1. 0612, 1. 0832,0. 9522,0. 0000, 1. 0774; P = 0. 7743, 0. 2904, 0. 2806,0. 3426,1. 0000,0. 2832）. The operative time,intraoperative blood loss, the preserved time of installing catheter, hospitalization time, postoperative morbidity rate and efficacy were compared between the two groups. Results The operation success rates were 100.0% （72/72） in TUPKEP group and 98.6% （69/70） in TURP group. The average operation time were （46.2 ±6.4）min and （58.4±9.6）min（t= 8. 9404, P=0.0000）, and the mean intraoperative blood loss were （105.9±12.2）ml and （148.6±14.3） ml （t = 19.1608, P = 0.0000） in TUPKEP and TURP groups respectively. The mean preserved time of installing catheter were （3.5±1.0）d and （5.0±1.0）d（t= 8. 9364,P=0. 0000）, and the average hospitalization time were （5.1±1.9）d and （7.0±2.6）d（t= 4. 9819,P= 0.0000）in the two groups, respectively. In TUPKEP group, there was one case of temporary urinary incontinence, two cases of secondary prostate hemorrhage and one case of external orifice stricture of urethra, with a complication rate of 5.56%. In TURP group, there were two cases of transurethral resection syndrome （TURS）, one case of urinary extravasation, two cases of temporary urinary incontinence, three cases of secondary prostate hemorrhage and two cases of external orifice stricture of urethra, with a complication rate of 14.29% . Compared with preoperation, Qmax was obviously increased and IPSS, RUV, QOL scores were decreased after follow- up for 3 months, but there were no significant differences in these parameters between the two conditions（t= 1. 1131,0. 2543,1. 2959,0. 7252; P=0. 2676,0. 7996,0. 1971,0. 4696）. Conclusions TUPKEP and TURP have similar efficacy in the treatment of BPH, but TUPKEP is a method with shorter operation time, less blood loss, lower postoperative complication rate and more safety than TURP.