经尿道等离子前列腺剜除联合膀胱小切口治疗重度前列腺增生

Transurethral Plasmakinetic Vaporization of the Prostate Combined with Enucleation Technique and Mini-incision in the Bladder for the Treatment of Large Benign Prostatic Hyperplasia

目的探讨等离子电切镜经尿道剜除前列腺,联合耻骨上膀胱小切口治疗重度前列腺增生的价值。方法应用等离子电切襻和镜鞘将增生前列腺从精阜上缘延外科包膜逆行推入膀胱,于耻骨上膀胱小切口将前列腺组织或膀胱结石取出。结果80例均顺利完成手术,剜除前列腺时间25～45min,(34.3±11.4)min;经耻骨上膀胱小切口取出腺体或膀胱结石时间15～25min,(20.4±5.8)min;术中出血量50～150ml,(80.2±16.5)ml,均未输血。术后膀胱冲洗时间14～24h,(16.5±4.8)h,拔除尿管时间3～6d,平均4.4d。无电切综合征、尿外渗、闭孔神经反射,1例出现暂时性尿失禁,未做特殊处理,1个月后症状消失。80例随访3～12个月,平均9.6月,无再出血和逆行射精等,术后1个月IPSS由术前(25.3±5.2)分降至术后(11.2±1.6)分(t=36.308,P=0.000);Qmax从术前(6.9±3.1)ml/s提高至(16.7±2.9)ml/s(t=-18.725,P=0.000)。结论经尿道等离子前列腺剜除联合膀胱小切口治疗重度前列腺增生或合并膀胱结石的患者,具有独特的临床应用价值。

Objective To evaluate the efficacy of transurethral plasmakinetic vaporization of the prostate combined with enucleation technique and mini-incision in the bladder for the treatment of large benign prostatic hyperplasia. Methods By utilizing wire loop and resectoscope sheath, we enucleated benign prostatic hyperplasia retrogradely from proximal end of the seminal colliculus to the bladder, and then removed the prostatic tissue and bladder calculus out of the bladder with a mini-incision on the abdominal wall.Totally 80 cases of large benign prostatic hyperplasia were treated and intraoperative bleeding volume, operation time, washing time, catheterization time and prognosis were evaluated. Results All of the 80 cases were treated successful via the procedure with a mean operation time of （34.3±11.4） min （range, 25-45 min） for enucleation, and （20.4±5.8） min （range, 15-25 min） for removing the tissues and bladder calculus. Intraoperative blood loss ranged from 50 to 150 ml （mean, 80.2±16.5）, no patients received blood transfusion. Postoperative bladder washing time ranged from 14 to 24 hours （mean, 16.5±4.8）, and then the ureteral catheter was withdrawn in 3-6 days （mean, 4.4 days）. No transurethral resection syndrome, urinous infiltration and obturator nerve reflex occurred in our patients. One case showed temporary urinary incontinence after the treatment and then recovered in one month spontaneously. The eighty cases were followed up for 3 to 12 months （mean,9.6 months）, during which no patient had hemorrhage or ejaculation. Re-examination carried out in one month after the surgery showed significantly decreased IPSS （from 25.3±5.2 to 11.2±1.6, t=36.308, P=0.000）, and increased Qmax [from （6.9±3.1） ml/s to （16.7±2.9） ml/s, t=-18.725,P=0.000]. Conclusion Transurethral plasmakinetic vaporization of the prostate combining enucleation technique and mini-incision in the bladder is feasible for the treatment of large benign prostatic hyperplasia, especial for the patients complicated with bladder calculus.