经尿道等离子双极电切术在高龄高危前列腺增生患者中的应用

Transurethral plasmakinetic resection of prostate in treatment of aged patients with benign prostatic hyperplasia at high risk

目的 探讨经尿道前列腺等离子电切术（PKRP）治疗高危前列腺增生症（BPH）的安全性及疗效。方法 回顾分析我院2009年3月至2013年2月接受PKRP治疗的165例高危BPH患者的临床资料，年龄70～84（73.3±5.6）岁。评估手术安全性，术后3个月时随访，对比手术前后排尿症状主客观指标变化。结果 本组手术时间32～125（67±23）min，切除前列腺质量16～86（46.3±24.2）g，出血50～154（85.0±23.1）ml，术中无输血病例，无经尿道电切综合征，无真性尿失禁，围术期安全，无1例发生原有合并症加重。165例患者规律随访，与术前比较，术后3个月最大尿流率（Qmax）由（6.9±3.8）ml/s升至（16.5±3.5）ml/s，国际前列腺症状评分（IPSS）由（21.6±5.8）分降至（7.3±4.2）分，生活质量评分（QOL）由（4.6±0.8）分降至（1.2±0.9）分，残余尿量（RUV） 由（65.2±31.6）ml降至（7.5±4.5）ml，差异均有统计学意义（P＜0.05）。结论 PKRP是治疗高龄高危BPH患者的安全、有效方法。

Objective To assess the safety and efficacy of transurethral plasmakinetic resection of prostate （PKRP） in the treatment of benign prostatic hyperplasia （BPH） in the aged patients at high risk. Methods Clinical data of 165 BPH patients at high risk with age of （73.3±5.6） years, ranging from 70 to 84 years, undergoing PKRP in our department from March 2009 to February 2013 were collected and retrospectively analyzed. The safety of PKRP was evaluated. All patients were followed up at least for 3 months. Parameters of urination were measured before PKRP and at 3 months after operation. Results The duration of procedure was （67±23）min ranging from 32 to 125min; the weight of resected prostate glands was （46.3±24.2）g, ranging from 16 to 86g; the blood loss was （85.0±23.1）ml, ranging from 50 to 154ml. There was no any case requiring blood transfusion; no transurethral resection syndrome or aggravation of original complication occurred during the operation and peri-operative period. All the 165 patients were followed up for 3 months at least, and no urinary incontinence was found after the operation. Compared with pre-operation, the peak flow rate was increased from （6.9±3.8） to （16.5±3.5）ml/s, while the international prostate symptom score （IPSS） was decreased from （21.6±5.8） to （7.3±4.2）, the quality of life （QOL） from （4.6±0.8） to （1.2±0.9）, and the residual urine volume （RUV） from （65.2±31.6） to （7.5±4.5）ml, respectively, on the 90th day postoperatively （P〈0.05）. Conclusion PKRP is a safe and effective treatment for BPH patients, especially for the aged patients at high risk.