经尿道等离子体双极前列腺电切术与经尿道前列腺电切术的疗效比较研究

Comparative effectiveness research of bipolar transurethral plasmakinetic resection of prostate and transurethral resection of prostate

目的:对比研究经尿道等离子体双极电切术(transurethral plasmakinetic resection of prostate,PKRP)及经尿道前列腺电切术(transurethral resection of prostate,TURP)的安全性与临床疗效。方法:纳入2010年3月至2012年9月78例有下尿路症状(lower urinary tract symptoms,LUTS)的良性前列腺增生(benign prostatic hyperplasia,BPH)患者,按1:1的比例随机分为两组,一组行PKRP(PKRP组),另一组行TURP(TURP组)。对比两组患者术前、术后(1个月、12个月)国际前列腺症状评分(international prostate symptom scores,IPSS)、最大尿流率(maximum flow-rate,Qmax)、生活质量(quality of life,QOL)、残余尿量(postvoid residual volume,PVR),围手术期基本情况,如手术时间、留置导尿管时间、膀胱冲洗量、住院时间;并发症发生率,如经尿道电切综合征(transurethral resection syndrome,TURS)、输血、尿潴留、尿道狭窄等。结果:两组患者手术时间、术中与术后冲洗液量、术后膀胱冲洗时间、包膜穿孔、尿道损伤、输血、尿潴留、二次手术、尿道狭窄发生率差异无统计学意义(P>0.05),PKRP组留置导尿管时间、住院时间明显少于TURP组。PKRP组无一例发生TURS,TURP组中6例患者发生TURS(P<0.05)。术后1个月、12个月两组患者IPSS、Qmax、QOL、PVR差异均无统计学意义,但两组患者IPSS评分均较术前显著下降,Qmax显著增高,PVR显著减少(P<0.05)。结论:PKRP与TURP具有相同的治疗效果,相较TURP,PKRP具有更短的留置导尿管时间、住院时间,发生TURS的风险更低;因此,PKRP是可供选择的前景良好的治疗BPH的微创术式。

Objective ：To comparatively investigate the safety and clinical effect of bipolar transurethral plasmakinetic resection of prostate （PKRP） and the transurethral resection of prostate （TURP） in the treatment of benign prostatic hyperplasia （BPH）. Meth- ods：From Mar. 2010 to Sep. 2012, a total of 78 patients with lower urinary tract symptoms related to BPH were enrolled into the study, they were randomly divided into two groups：39 patients underwent PKRP, and 39 patients underwent standard TURP. International pros- tate symptom scores （IPSS） ,maximum flow-rate （Qmax） ,quality of life （QOL） and postvoid residual volume （PVR） were performed for each patient both preoperatively and postoperatively （first month and first year）. Operation time, urethral catheterization time, irriga- ted volume, hospital stay, the complications such as transurethral resection syndrome （TURS）, transfusion, urinary retention and urinary stricture of the 2 groups were compared. Results： There were no significant differences in operative time, intraoperative and postoperative irrigated volume, postoperative irrigated time of urinary bladder and incidence of complications （ capsule perforation, urethral injury, transfusion, retention of urine, reoperation, urethral stricture） between the 2 groups （ P 〉 0.05 ）. While the urethral catheterization time and hospital stay in the PKRP group were less than those in the TURP group （P 〈 0.05 ）. During the operation no TURS occurred in the PKRP group, while 6 patients in TURP group suffered from TURS （P 〈 O. 05 ）. In the first month and twelfth month after operation, there was no significantly statistical difference in IPSS, Qmax, QOL and PVR between the 2 groups, but compared with preoperative da- ta,IPSS and PVR significantly decreased and Qmax significantly increased. Conclusions： PKRP has the same therapeutic efficacy as TURP for BPH. Moreover,it makes a promising treatment for BPH with its advantages, such as early removal of postoperative urethral catheter, a shorter hospital stay and the absence of TURS risk when compared with TURP. So, PKRP is a reliable minimally invasive technique and may anticipatorily prove to be an alternative electrosurgical procedure for the treatment of BPH.