术中膀胱造瘘低压灌注对前列腺增生患者的手术效果及并发症的影响

The surgical effect and complication of FPKRP in BPH patients under bladder low-pressure perfusion with cystostomy

目的探讨术中膀胱造瘘低压灌注对前列腺增生(BPH)患者的手术效果及并发症的影响,为治疗BPH提供较好的微创手术方法。方法选择2011年2月-2012年5月新疆医科大学第六附属医院泌尿外科需手术治疗的62例BPH患者,其中36例(试验组)行低压(膀胱灌注压力为30cmH2O)灌注下经尿道四区分割法双极等离子体前列腺部分剜切术(FPKRP),26例(对照组)常规压力(膀胱灌注压力为60cmH2O)灌注下行FPKRP。观察并比较两组手术时间、术中出血量、术后留置导尿管时间及手术前后前列腺症状评分(IPSS)、生活质量评分(BPHQLS)、国际前列腺生活质量评分(ZPQoL)、剩余尿量(RUV)、最大尿流率(Qmax)的差异。结果试验组患者术后24h内拔出膀胱造瘘管,两组导尿管均在术后3～5d予以拔除,排尿通畅,术后患者5～7d出院。病理检查回报均符合前列腺结节样增生改变。术后随访3个月,试验组1例失访(因其它疾病死亡)。试验组手术时间短于对照组,术中出血量低于对照组,差异有统计学意义(P<0.05)。试验组和对照组术后RUV值较术前明显降低,而Qmax值较术前明显提高,差异有统计学意义(P<0.05)。试验组泌尿系感染发生率低于对照组,差异有统计学意义(P<0.05),两组术后尿道狭窄、尿失禁发生率差异无统计学意义(P>0.05)。两组术后IPSS、IPQoL较术前均明显降低,差异有统计学意义(P<0.05)。试验组术后IPSS低于对照组,而IPQoL与对照组比较差异无统计学意义(P>0.05),两组术后BPHQLS得分均得到提高,差异有统计学意义(P<0.05)。两组疾病维度与满意度提高最为明显,其次为生理、社会及心理维度,但试验组与对照组术后各维度比较差异无统计学意义(P>0.05)。结论低压灌注无前列腺电切综合征(TURS)的发生,既保证切割视野清晰,又保证膀胱低压充盈,提高患者耐受性,增加安全性。

Objective To evaluate the surgical effect and complication of FPKRP in BPH patients under bladder low-pressure perfusion with Cystostomy. Motheds From February 2011 to May 2012 in the Sixth Affiliated Hospital of Xinjiang Medical University 62 patients were treated with BPH require surgery, of which 36 cases （test group） underwent line of low-voltage （bladder perfusion pressure 30 cmH2O） with FPKRP, 26 patients （control group） underwent conventional pressure （bladder perfusion pressure of 60 cmH2O） perfusion downlink FPKRP. Operative time, blood loss, operative time, blood loss, postoperative indwelling catheter time and before and after surgery, prostate symptom score （IPSS）, quality of life score （QOL）, residual urine volume （RUV）, differences in maximum urinary flow rate （Qmax） of two groups were observed and compared. Resluts The test group patients were pulled out bladder fistula within 24 h after operation, two groups in 3--5 d after catheter were un discharged. Return on pathological examination were in line with pl th ug urination, patients after 5-- 7 d e prostatic nodular hyperplasia changed. The patients were followed up for 3 months, in the test group 1 patient was lost to follow-up （death） due to other diseases. Short operation time of the test group than the control group, the inu＇aoper- ative blood loss was lower than the control group, the difference was statistically significant （P d0.05）, resection of prostate weight and postoperative indwelling catheterization time was not statistically signifi cant between two groups （P 〉0.05）. Test and er than the preoperative Qmax values improved control groups after PVRRUV value was significantly low significantly compared with the preoperative difference was statistically significant （P 〉0.05）. The preoperative and postoperative PVRRUV, Qmax was no signifi cant difference between groups （P 〈0.05）. Test group urinary tract infection incidence was lower than the control group, the difference was statistically significant （P 〈0.05）., postoperative urethral stricture, the incidence of urinary incontinence by the difference between the two groups were statistically significant （P 〉0.05）. IPSS, IPQoL were significantly reduced than before surgery, and the difference was statistically significant （P 〈0.05）. The postoperative BPHQLS scores improved, the difference was statistically signif icant （P 〈0.05）. Each dimension with the satisfaction of the two groups of diseases to improve the most obvious, followed by the physical, social and psychological dimensions, each dimension of the test group and the control group, postoperative difference was not statistically significant （P 〉0.05）. Conclusion Using low-pressure perfusion has no occurrence of prostate TURP syndrome （TURS）, both to ensure cutting clear vision, but also to ensure that the bladder low pressure filling, improve patient tolerance and increase security.