经尿道前列腺剜除术与电切术治疗不同质量良性前列腺增生的前瞻性研究

A prospective study of transurethral resection of prostate and transurethral enucleation of prostate for benign prostatic hyperplasia according to different weights of prostate

目的比较研究经尿道前列腺等离子剜除术（TPKEP）与经尿道前列腺电切术（TURP）治疗不同质量良性前列腺增生（BPH）的临床效果。方法2009年1月至2011年3月对245例BPH患者进行前瞻性研究。根据随机数字表将患者随机分为2组，TPKEP组123例，TURP组122例。将所有患者按术前前列腺质量分为3组，〈40g组67例、40～70g组96例和〉70g组82例。比较3组患者按两种手术方法的治疗效果，分别对比手术时间、切除前列腺组织质量、术后并发症、最大尿流率（Qmax）的改善、手术前后PSA变化等指标。结果〈40g组两种手术方式在同手术期指标及术后3个月随访主要指标等方面比较差异均无统计学意义（P〉0．05）。40～70g组中，TPKEP组前列腺切除质量（36．2±12．5）g大于TURP组（30．2±13．1）g（P〈0．05），出血量（70．1±10．4）ml少于TURP组（81．3±11．3）ml（p〈0．05），术后PSA下降水平（2．6±0．3）μg／L大于TURP组（2．1±0．6）μg／L（P〈O．05）。〉70g组两种手术方式围手术各项指标对比差异均有统计学意义（P〈0．05），术后3个月随访主要指标中TPKEP组术后PSA下降程度（3．4±0．3）μg／L及Qmax增加程度（18．6±3．5）ml／s大于TURP组[PSA下降（2．3±0．7）pg／L，Qmax增加（16．6±3．4）ml／s]（P〈0．05），其余方面（IPSS、残余尿等）差异无统计学意义（P〉0．05）。在并发症方面，TPKEP组输血率（3例）低于TURP组（12例），但是假性尿失禁（17例）发生率高于TURP组（6例）（P〈0．05）。结论TPKEP能够更快更彻底地切除增生前列腺腺体，术中出血少，安全性好，对于大体积的前列腺患者TPKEP具有较明显优势。TPKEP围手术期及远期疗效在小前列腺组并不优于TURP，对于中等大小前列腺患者二者疗效相当。

Objective To compare the clinical effect of transurethral plasma kinetic euucleation of prostate （TPKEP） and transurethral resection of prostat （TURP） for benign prostatic hyperplasia （BPH） according to different weights of prostate. Methods 245 cases of BPH were divided into two groups randomly. 122 cases underwent TURP and 123 cases underwent TPKEP. All cases were divided into three subgroups： 67 cases in 〈40 g group, 96 cases in 40-70 g group and 82 cases in 〉70 g group, according to difZ ferent weights of prostate. Perioperative parameters and short-term outcomes between two groups were compared. Results In the 〈40 g subgroup there was no significant difference between two groups in periopera- tire factors and short-term outcomes （P〉0.05） .In the 40-70 g subgroup, tissue reseeted by TPKEP was significantly more than that by TURP （ 30.2± 13.1 g versus 30.2± 13.1 g, P〈0.05） . The intraoperative blood loss was less in TPKEP group than that in TURP group （70.1±10.4 ml versus 81.3±11.3 ml, P〈0.05）. The decline of prostate specific antigen （PSA） was more dramatically in TPKEP group than that in TURP group after 3 months （2.6±0.3 g/L versus 2.1±0.6μg/L, P〈0.05）. In the 〉70 g subgroup, the decline of PSA level was （3.4±0.3） μg/L after 3 months in TPKEP group, more than （2.3±0.7）μg/L in TURP group （P〈0.05）. The increase of Qmax after 3 months in TPKEP group was （18.6±3.5） ml/s, more than （ 16.6± 3.4） ml/s in TURP group （P〈0.05）. There was no significant difference between the two groups in international prostate symptoms score and residual urine volume （P〉0.05）. The transfusion rate for TPKEP （3 ea- ses） were lower than that for TURP （12 cases） （P〈0.05）, but the incidence of false incontinence for TPKEP （17 cases） were higher than that for TURP （6 cases） （P〈0.05）. Conclusions Compared with TURP, TPKEP resect the entire prostate with the advantages of less blood loss and more effective for a large prostate. TPKEP had no advantage for small prostate, and the medical results are equivalencies in prostate with medium size.