三种经尿道术式治疗良性前列腺增生的疗效比较

Clinical efficacy evaluation of three transurethral electroresection methods for benign prostatic hyperplasia

目的比较经尿道前列腺汽化术（TUVP）、经尿道前列腺汽化切割术（TUEVAP）、经尿道前列腺电切术（TURP）3种手术方法治疗良性前列腺增生（BPH）的疗效及并发症。方法先后分别采用TUVP、TUEVAP、TURP治疗BPH患者1298例。TUVP组204例,年龄53-86岁（平均71岁）,前列腺重量21-125g（平均51g）。TUEVAP组256例,年龄56-91岁（平均73岁）,前列腺重量23-146g（平均53g）。TURP组838例,年龄59-97岁（平均75岁）,前列腺重量20-245g（平均56g）。3组病例术前前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）、剩余尿量（PVR）比较差异均无统计学意义（P〉0.05）。比较3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效果。结果三组中除TUEVAP组最初1例合并膀胱结石采用大力钳碎石时损伤膀胱壁而中转手术外,均手术成功。TUVP、TUEVAP、TURP组平均手术时间分别为61（30-180）min、63（20-240）min、50（20-270）min,组间比较差异无统计学意义（P〉0.05）。3组术中平均出血量分别为87（20-150）ml、82（20-200）ml、86（20-300）ml,组间比较差异有统计学意义（P〈0.05）;3组手术后平均留置尿管时间分别为5.4d、5.4d、4.1d;术后平均住院时间分别为6.7d、6.5d、4.5d（P〈0.05）。TUVP、TUEVAP组术后拔管不能排尿、尿道狭窄、继发性出血、暂时性尿失禁、尿路感染的发生率明显高于TURP组（P〈0.05）。术后3个月随访,3组IPSS、PVR、QOL均较手术前明显下降,Qmax均较手术前明显增加,但组间比较差异均无统计学意义（P〉0.05）。结论 TUVP,TUEVAP,TURP治疗BPH均有明确的临床效果,TURP术后并发症明显少于TUVP、TUEVAP,TURP是熟练者快捷、高效的选择,仍然是治疗BPH的＂金标准＂。

Objective To compare the clinical efficacy and complications of transurethral vapor resection of the prostate （TU-VP）, transurethral electrovaporization ablation prostatectomy （TUEVAP） and trasurethral resection of prostate （TURP） for benign prostatic hyperplasia （BPH）. Methods A total of 1298 patients with BPH were enrolled in our investigation. Of 204 cases aged 53-86 years（mean, 71 years） with prostate weight of 21-125 g（mean, 51 g） underwent TUVP, 256 cases aged 56-91 years（mean, 73 years） with prostate weight of 23-146 g（mean, 53 g） underwent TUEVAP, 838 cases aged 59-97 years（mean, 75 years） with prostate weight of 20-245 g （mean, 56 g） underwent TURP. The IPSS, QOL, maximum urine flow rate （Qmax） and postvoid residual urine （PVR） among the 3 groups preoperative had no statistically difference （P〉0.05）. The operative time, blood loss, catheterization time, hospital stay and complications were compared. Results All of the operations were performed successfully except that 1 case was coverted to open surgery because of bladder injury when treaing the bladder stone by mechanical lithorispsy in TUEVAP group. The mean operative time was 61 min （range, 30-180 min）, 63 min （20-240 min）, 50 min （20-270 min） （P〈0.05）; the blood loss was 87 ml （ range, 20-150 ml）, 82 ml （ range, 20-200 ml）, 86 ml（range, 20-300 ml） （P〈0.05）; the mean catheterization time was 5.4 day, 5.4 day and 4.1 day （P〈0.05）; the mean hospital stay was 6.7 day, 6.5 day and 4.5 day （P〉0.05）. In TUVP and TUEVAP groups, the conditions such as urine retention after catheter removal, urethral stricture, secondary hemorrhage, temporary incontinence and urethritis occurred significantly higher than TURP group （P〈0.01）. In 3 months of follow-up, it showed obvious decrease in IPSS, PVR, QOL scores and increase in Qmax scores. However, There was no significant difference among these 3 groups （P〉0.05）. Conclusions All these 3 transurethral electresection procedures have significant efficacy in the treatment of BPH. The postoperative complications of TURP was less than TUVP and TUEVAP significantly. TURP may be an efficient choose for skilled surgeon and it was still the gold standard treatment method for BPH.