药物和微创手术治疗良性前列腺增生症的疗效分析

Effect of drugs and minimally invasive surgery on benign prostatic hyperplasia

目的探讨微创手术联合药物治疗良性前列腺增生症(BPH)的临床疗效。方法选择BPH患者129例,随机分为经尿道前列腺电切术(TURP)组和经尿道前列腺气化电切术(TUVP)组,两组患者分别根据术后是否应用BPH药物治疗分为观察组和对照组,对照组给予常规治疗和护理,观察组在对照组治疗的基础上给予BPH药物治疗;记录TURP组和TUVP组手术前后患者国际前列腺症状评分(IPSS)、最大尿流率(MFR)、生活质量评分(QOLS)和残余尿量(PVR)以及术中手术时间、出血量、膀胱冲洗、导尿管留置和住院时间;随访2年,记录TURP观察组和对照组以及TUVP观察组和对照组患者IPSS、QOLS、MFR、前列腺体积(PV)、血清前列腺特异性抗原(PSA)水平以及相关并发症等。结果 TUVP组患者术中出血量、膀胱冲洗时间、尿管留置时间以及住院时间明显少于TURP组,差异均有统计学意义(t分别=8.87、11.86、23.96、3.19,P均<0.05)。与手术前比较,手术后TURP组和TUVP组患者IPSS、QOLS和PVR明显减少,而MFR明显升高,差异均有统计学意义(t分别=3.94、2.80、5.29、3.38;4.02、2.72、4.87、2.93,P均<0.05)。随访2年后,TURP和TUVP组观察组患者IPSS、PV明显低于同组的对照组,而MFR明显高于同组的对照组,差异均有统计学意义(t分别=3.12、4.37、2.34;2.62、2.55、2.30,P均<0.05);患者主要并发症为排尿困难和BPH复发,各手术组观察组并发症发生率与对照组比较,差异均有统计学意义(χ2分别=4.14、38.12、2.56、3.52,P均<0.05)。结论两种手术方式均可有效治疗BPH,微创手术联合药物治疗BPH对术后远期并发症的预防具有较好的临床疗效。

Objective To explore the clinical efficacy of minimally invasive surgery combined with drug for benign pro- static hyperplasia （BPH）. Methods A tatal of 129 cases of patients with BPH were selected receiving transurethral resec- tion （TURP） or transurethral vaporization of prostate transurethral surgery （TUVP） treatment respectively. The two groups of patients were randomly divided into control group and observation group based on whether using BPH medication after surgery. The international prostate symptom score （IPSS）, maximum urinary flow rate （MFR）, residual urine volume （PVR） and quality of life score （QOLS） before and after surgery, and intraoperative surgical time, blood loss, bladder ir- rigation, catheterization and hospitalization time in group of TURP and TUVP were compared. The IPSS, QOLS, MFR, prostate volume （PV）, serum prostate-specific antigen （PSA） levels and related complications were recorded after two years follow-up. Results The blood loss, bladder irrigation, indwelling catheter time and hospital stay in TUVP group were significantly less than those of the TURP group （t=8.87,11.86,23.96,3.19 ,P〈0.05 ）. Compared with preoperation, the IPSS, QOLS and PVR in TURP and TUVP groups were significantly decreased while the MFR significantly increased postopera- tion（t=3.94,2.80,5.29,3.38;4.02,2.72,4.87,2.93 ,P〈O.05）. The IPSS, PV of observation group of TURP and TUVP were significantly lower than those of the the control group while the MFR significantly increased after 2 years follow-up （t= 3.12,4.37,2.34; 2.62,2.55,2.30, P〈 0.05）. The main complications were dysuria and BPH recurrence, the incidence of com- plications of observation group of TURP and TUVP had statistical differences compared with those of the control group（x2= 4.14.38.12.2.56.3.52.P〈0.05）. Conclusions Both TURP and TUVP can treat BPH effectively. Minimally invasivesurgery combined with drug treatment for BPH have better clinical efficacy on preventing long-term postoperative compli- cations.