腹腔镜手术治疗大体积良性前列腺增生症

Surgical treatment of benign prostatic hyperplasia with large volume by laparoscopy

目的探讨腹腔镜治疗大体积良性前列腺增生症(BPH)的技术要点和临床疗效。方法大体积BPH患者12例,采用腹腔镜经膀胱前列腺剜除术。3例合并膀胱多发结石,结石直径2.5-4.6cm,2例伴有膀胱憩室。前列腺体积大于80ml。记录手术时间、术中出血量、术后膀胱冲洗时间,随访手术效果。结果 12例均一次手术成功,病理诊断BPH。同时处理结石和憩室。手术时间75-180min,术中出血80-360ml。术后膀胱冲洗0.5-3.0d,9-14d拔除导尿管。最大尿流率由(5.24±4.06)ml/s提高至(20.6±5.62)ml/s。术后无尿失禁、尿潴留或排尿困难等并发症发生。结论对大体积BPH患者行腹腔镜经膀胱前列腺剜除术具有创伤小、失血少、术后疼痛轻、住院时间短、疗效可靠等优点。

Objective To discuss the technical detail and clinical effect of laparoscopic surgery for large volume benign prostatic hyperplasia （BPH）. Methods Laparoscopic prostatectomy was performed in 12 cases with large volume（〉80 ml） BPH, in whom 3 cases were complicated with bladder stones of 2.5-4.6 cm in diameter and 2 cases with vesical diverticulum. The operation time, blood loss, bladder irrigation time were recorded and operative effect evaluated. Results The operations were successful and BPH was diagnosed pathologically. The bladder stones and diverticulum were treated at the same time. The operation time lasted for 75-180 rain with blood loss of 80-360 ml. The bladder irrigation lasted for 1.5-4. 0 days and. The urine catheters were removed 9-14 days without complications of incontinence, retention and dysuria etc. after operation. The maximum urinary flow rate was increased from （5.24±4. 06） ml/s before operation to （20. 6± 5.62） ml/s after. Conclusion Compared to traditional open surgery, laparoscopic prostatectomy for large volume BPH has the advantages of minimal trauma, less blood loss and postoperative pain, and quicker recovery.