三种手术方式治疗大体积前列腺增生症的疗效比较

Comparison of Three Procedures for the Treatment of Large Volume Benign Prostatic Hyperplasia

【目的】比较经尿道等离子前列腺剜除术（PKEP）、经尿道双极等离子前列腺切除术（PKRP）和开放耻骨上前列腺摘除术（OP）治疗大体积前列腺增生症的疗效和并发症。【方法】选择2007年1月至2009年6月入本院接受手术治疗的大体积良性前列腺增生（BPH）患者60例，随机分为三组，分别接受PKRP（n=20）、PKEP（n=20）和OP（n=20）治疗。观察并比较三组手术时间、切除腺体重量、出血量、术后膀胱持续冲洗时间、术后留置导尿时间、术后住院天数以及尿失禁等并发症。术后均随访3年。分别于术后1、6、12、24、36个月行IPSS及QOL评分、最大尿流率（Qmax）及残余尿量测定。【结果】OP组手术时间最短、切除组织最多，但出血量最多、术后尿管留置时间和术后住院时间最长（与PKEP组和PKRP组相比P均〈0．05）。PKEP组出血量最少、尿管留置时间和术后住院时间最短（与OP组和PKRP组相比P均〈0．05）。随访结果表明，PKEP组的远期疗效与OP组相当，均优于PKRP组（P〈0．05）。【结论】PKRP、PKEP和OP均能显著改善大体积前列腺增生的排尿症状。但PKEP创伤小、安全高、远期疗效好，是治疗大体积前列腺增生的优先选择。

[Objective] To compare the efficacy and complications of plasmakinetic resection of the prostate （PKRP）, plasmakinetic enucleation of the prostate （PKEP） and open prostatectomy（OP） for the treatment of large volume benign prostatic hyperplasia（BPH）. [Methods]From January 2007 to June 2009, 60 patients with large vol- ume BPH in our hospital were randomized to PKRP group（ n = 20）, PKEP group（ n ： 20） and OP group（ n = 20）. Operation time, resected tissue weight, blood loss, postoperative bladder irrigation time, postoperative catheterization time, postoperative hospital stay and complications such as urinary incontinence were observed and compared among 3 groups. All patients were followed up for 3 years. IPSS, QOL scores, Qmax and residual urine were determined at 1, 6, 12, 24, and 36 months postoperatively, respectively. [Results]Compared with PKRP group and PKEP group, shorter operation time, more resected tissue weight, more blood loss, longer catherization time and postoperative hos- pital stay were observed in OP group（all P d0.05）. Compared with OP group and PKRP group, less blood loss, shorter catheterization time and postoperative hospital stay were observed in PKEP group（all P d0.05）. The 3-year follow-up data showed that the long-term efficacy of PKEP was equivalent to OP and superior to PKRP. [Conclu- sion]PKRP, PKEP and OP can all improve the micturition symptoms of large-volume BPH. PKEP has less invasion, higher security and better long-term efficacy, so it should be considered as the priority of choice for the treatment of large-volume BPH.