经尿道等离子双极电切术治疗良性前列腺增生880例报告

Transurethral Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia:Report of 880 Cases

目的探讨经尿道等离子双极电切术治疗良性前列腺增生的安全性和疗效。方法采用英国Gyrus等离子双极电切治疗良性前列腺增生880例,术后生理盐水冲洗1～2 d,导尿管3～5 d拔除。880例中,术后640例获得随访,随访时间4～50个月,平均24.5个月。结果 880例手术均获成功,手术时间（65.0±12.0）min;术中出血量10～480 mL,平均80.0 mL±15.0 mL,早期有20例术中输血200～400 mL;术后24 h内出血再次手术止血30例,无经尿道电切综合征和闭孔神经反射发生。随访5年无再次需要前列腺电切手术病例;术后发生前尿道炎性狭窄54例,均为尿道外口处狭窄,门诊经尿道扩张后治愈;无尿失禁发生。880例术后6个月,最大尿流率（Qmax）由术前（7.4±2.2）mL/s升高到术后（22.6±2.4）mL/s（P〈0.001）;国际前列腺症状评分由术前（26.8±1.8）分降到术后（6.8±1.2）分（P〈0.01）;生活质量评分由术前（4.2±0.3）分降到术后（1.8±0.8）分（P〈0.01）。术后6个月Qmax、IPSS评分和QOL评分与术后12个月和24个月相比无统计学差异（P〉0.05）。结论经尿道等离子双极电切是治疗BPH的一种安全有效的方法 。

Objective To discuss the eficacy and safety of transurethral plasmakinetic resection of the prostate（PKRP）for benign prostatic hyperplasia（BPH）.Methods A British made Bipolar plasmakinetic resection system（Gyrus）was employed in 880 cases of benign prostatic hyperplasia.A three-channel catheter was indwelled for 3 to 5 days after the operation.Results The procedure was completed successfully in all of the cases with a mean operation time of（65.0±12.0）min,and blood loss 10 to 480 mL（80.0±15.0）mL.Twenty patients received blood transfusion during the operation（200 to 400 mL）.In 24 hours of operation,thirty patients blood too much to operate again.No case showed transurethral resection syndrome or obturator nerve reflex.Fifty-four patients developed inflammatory stricture of the anterior ureter and was then cured by dilating the urinary tract.Follow-up was available in the patients for 1 to 6 months,during which the mean Qmax of the patients significantly increased compared to that preoperation from（7.4±2.2）mL/s to（22.6±2.4）mL/s,P0.01,and the IPSS and life quality score markedly decreased from 26.8±1.8 and 4.2±0.3 to 6.8±1.2 and 1.8±0.8;P0.001 and 0.05,respectively.Conclusion PKRP should be an effective and safe treatment for BPH.