经尿道等离子前列腺剜除术治疗大体积良性前列腺增生

Transurethral Plasmakinetic Enucleation of Prostate for the Treatment of Large Benign Prostatic Hyperplasia

【目的】评价经尿道前列腺等离子腔内剜除（PKEP）治疗大体积良性前列腺增生（BPH）的疗效和安全性。【方法130例前列腺重量〉100g患者行PKEP治疗，对患者术前、术后的国际前列腺症状评分（IPSS）、最大尿流率（Omax）、剩余尿量（PVR）进行比较，分析手术时间、术中、术后血红蛋白和血清钠的变化、前列腺切除重量、膀胱冲洗时间、留置导尿管时间、住院天数及手术并发症。术后随访3个月。【结果】手术时间121～164min，平均132．3min，切除的标本组织重量96～128g，平均107．6g。术中视野清晰，出血极少，均无输血；整个手术经过平稳，无前列腺电切综合征和其它严重并发症发生。术后留置尿管3～5d，平均3．9d；术后膀胱冲洗时间2．9（1～4）d；术后住院3～8d，平均5．1d。术后随访3个月，排尿梗阻症状明显改善，IPSS由术前的22．3±3．4降至4．8±1．4（P〈0．01）。Omax由术前的（8．1±0．6）升至（24．5±4．8）mL／s（P〈0．01）。PVR由（46．1±9．70）mL降至（2．4±1．6）mL（P〈0．01）。【结论】PKEP治疗大体积前列腺增生高效、微创、安全、并发症少、住院时间短，是治疗大体积前列腺增生的一种安全而有效的方法。

[Objective]To evaluate the safety and effectiveness of transurethral plasmakinetic enucleation of prostate （PKEP） for the treatment of large benign prostatic hyperplasia（BPH）. [Methods] Thirty BPH cases with the prostate greater than 100g underwent PKEP. International prostatic symptom scores（IPSS）, maximum urinary flow rate （Qmax） and postvoid residual volume（PVR） were compared between before and after operation. The operation time, hemoglobin, serum sodium, the weight of resected prostate weight, bladder irrigating time, catheterization time, length of stay and complications were analyzed. Patients were followed up for 3 months. [Results] The mean operation time was 132.3min （121~164min）. The mean specimen weight was 107.6g（96~128g）. The visual field was clear. The bleeding volume was less and no transfusion needed. The procedure was steady, and no TUR syndrome and other major complications oc- curred. The average postoperative catheter duration was 3.9 days（3~5）, and the average bladder irrigating time was 2. 9 days（1~4 days）. The average postoperative hospital stay was 5.1 days（3~8 days）. All patients were followed up for 3 months. The urination symptoms were markedly improved. IPSS decreased from 22.3 ±3.4 to 4. 8 ±1.4 （ P 〈0.01）. Qmax increased from 8.1±0.6 to 24.5±4.8（ P 〈0.01）. PVR decreased from 46.1±9.7 to 2.4±1.6（ P 〈0.01）. [Conclusion] PKEP for the treatment of large BPH has high effectiveness, safety, less complication and short hospital day, so it is a safe and effective method.