经尿道前列腺电切术和等离子双极电切术治疗良性前列腺增生的比较

Comparison of Transurethral Resection of Prostate and Bipolar Plasma Kinetic Resection of Prostate for Benign Prostatic Hyperplasia

目的比较分析经尿道前列腺电切术(TURP)和经尿道前列腺等离子双极电切术(PKRP)治疗良性前列腺增生(BPH)的安全性和治疗效果。方法将80例BPH患者按随机数字表法分为TURP组和PKRP组,每组40例。2组患者手术均采用连续硬膜外麻醉。TURP组采用KARL STORZ史托斯电切镜、PKRP组采用GYRUS等离子双极电切镜进行手术,2组手术方式相同:先于膀胱颈6点钟处切一个深达包膜的标志沟至精阜,切除范围以膀胱颈和精阜为标志点,切除深度尽可能达前列腺外科包膜层。切割完毕后彻底止血,尿道留置导尿管,膀胱持续冲洗并抗感染治疗3 d。对2组术前及术后3、6个月的国际前列腺症状评分(IPSS),生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量(RUV)的变化,手术时间、术后膀胱冲洗时间、留置导尿时间、术后住院时间及并发症的发生率进行比较。结果 TURP组术中出血量及并发症发生率分别为(358.2±94.5)mL及42.5%,PKRP组术中出血量及并发症的发生率分别为(125.7±78.3)mL及15.0%,2组比较差异均有统计学意义(均P<0.05)。术后经3、6个月的随访,2组患者的IPSS、QOL、RUV与术前比较有较大程度的下降,Qmax与术前比较则有显著提高(均P<0.05);2组同时间段上述指标比较差异均无统计学意义(均P>0.05)。结论 TURP和PKRP均为治疗BPH的有效术式,且近期疗效相似,但PKRP术中出血量少,术后并发症发生率低,安全性更高。

Objective （TURP） and bipolar plasma To compare the safety and efficacy of transurethral resection of prostate kinetic resection of prostate （PKRP） in the treatment of benign prostatic hyperplasia （BPH）. Methods Eighty BPH patients were randomly assigned to receive either TURP or PKRP under continuous epidural anesthesia. The procedures were performed using KARL STORZ resectoscope and bipolar GYRUS Plasma Kinetic System in TURP group and PKRP group, respectively. The same surgical procedures were performed in both groups： a canal reaching deep into envelope was cut to seminal colliculus at 6 o＇clock position at the vesical neck. Seminal colliculus and vesical neck were the markers for excision area and the depth reached envelope as far as possible. Complete hemostasis was performed and urethral indwelling catheter was used after cutting. Then, continuous bladder flushing and anti-infective therapy were given for 3 days. The international prostate symptomscore （IPSS）, quality of life score （QOL）, maximal urinary flow rate （Qmax）, residual urine volume （RUV）, operative time, bladder irrigation time, catheterization time, hospital stay and complications were compared between the two groups before and 3 and 6 months after operation. Results The intraoperative blood loss and complication rate were, respectively, （358.2±94.5） mL and 42.5% in TURP group, and （125.7±78.3） mL and 15.0% in PKRP group. There were significant differences in the two groups （P〈0.05）. After 3-6 months of follow-up, IPSS, QOL and RUV significantly decreased but Qmax increased in both groups （P〈0.05）. No significant differences were observed between the two groups in the same period （P〉0.05）. Conclusion TURP and PKRP have similar short-term efficacy in the treatment of BPH. However, PKRP is superior to TURP for reducing intraoperative blood loss and complications and enhancing safety.