经尿道超脉冲等离子体双极电切术联合腔内剜除法治疗良性前列腺增生症210例报告

Bipolar Plasmakinetic Superpulse Transurethral Resection of the Prostate and Intraluminal Enucleation for Benign Prostatic Hyperplasia:Report of 210 Cases

目的探讨经尿道超脉冲等离子体双极电切术(bipolar plasmakinetic superpulse transurethral resection of the prostate,PKSP+TURP)联合腔内剜除法治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)的临床疗效。方法2006年1月～2008年5月,采用英国Gyrus公司经尿道超脉冲等离子体双极电切与影像系统行PKSP+TURP联合腔内剜除法治疗BPH210例。腺体不大者,直接剜除后行PKSP+TURP;腺体较大、中叶增生明显者,先剜除中叶,行PKSP+TURP后剜除两侧叶,再行PKSP+TURP;腺体较大、两侧叶增生明显者,分别剜除两侧叶,同时行PKSP+TURP。结果手术时间20～130min,平均50.2min;术中出血量15～210ml,平均62.1ml。未发生电切综合征和膀胱穿孔等并发症。术后留置导尿管2～9d。210例随访2～30个月,IPSS由(23.8±4.7)分下降至(6.8±2.3)分(t=56.851,P=0.000),QOL由(4.3±0.8)分下降至(2.2±0.6)分(t=22.755,P=0.000),Qmax由(8.0±2.5)ml/s上升至(23.5±12.5)ml/s(t=-21.602,P=0.000),RU由(74.3±30.6)ml减少至(25.6±18.6)ml(t=11.315,P=0.000)。结论PKSP+TURP联合腔内剜除法治疗BPH,具有安全、并发症少、疗效确切等优点。

Objective To evaluate the clinical efficacy of bipolar plasmakinetic superpulse transurethral resection of the prostate （PKSP＋TUPR） plus intraluminal enucleation in the treatment of benign prostatic hyperplasia （BPH）. Methods A total of 210 cases of BPH treated with PKSP＋TURP combined with intraluminal enucleation were reviewed retrospectively. According to ROUS standard, there were 72 cases of grade Ⅱ BPH, 86 cases of grade Ⅲ, and 52 cases of grade Ⅳ in our series. The operation time,intraoperative blood loss, catherization time, transurethal resection syndrome （TURS） occurrence, hospital stay, IPSS, quality of life （QOL）, residual urine （RU） volume, and peak urine flow rate （Qmax） were observed. Methods of operation were selected according to the size of the prostate and severity of hyperplasia. For patients without large prostate, PKSP＋TURP were performed after the resection of the prostate. If the prostate middle lobe was severely enlarged, we carried out PKSP＋TURP after removing the middle lobe, and then resected the lateral lobes. If the side lobes were severely enlarged, PKSP＋TURP were performed at the same time when we resected the side lobes. Results The operation time ranged from 20 to 130 minutes, averaged 50.2 minutes. Intraoperative blood loss ranged from 15 to 210 ml with a mean of 62.1 ml. No TURS or bladder rupture occurred after the surgery. The catheter was maintained for 2-9 days postoperatively. The average hospital stay was 6.7 days. All the cases were followed up for 2 to 30 months. During which the IPSS decreased from 23.8±4.7 to 6.8±2.3 （t=56.851, P=0.000）; QOL decreased from 4.3±0.8 to 2.2±0.6 （t=22.755, P=0.000）; Qmax increased from （8.0±2.5）ml/s to （23.5±12.5）ml/s （t=-21.602, P=0.000）; and RU volume decreased from （74.3±30.6） ml to （25.6±18.6） ml （t=11.315, P=0.000）. Conclusion PKSP＋TURP combined with intraluminal enucleation has advantages of high safety, low rate of complications, and satisfactory outcomes for the treatment of benign prostatic hyperplasia.