经尿道等离子体前列腺剜除术和切除术运用于Ⅳ度前列腺增生的对比研究

Comparison of transurethral plasmakinetic enucleation and resection of prostate for the degree Ⅳ benign prostatic hyperplasia

目的比较经尿道等离子体前列腺剜除术(PKEP)与经尿道等离子体前列腺切除术(PKRP)在Ⅳ度良性前列腺增生(BPH)的临床疗效。方法将具有手术指征的100例Ⅳ度BPH患者随机分为两组,分别行PKEP和PKRP,监测记录患者围手术期和术后随访1年的临床资料(包括手术时间、切除前列腺重量、术中出血量、术后膀胱冲洗时间、留置尿管时间和住院时间,以及术后1年国际前列腺症状评分、生活质量评分、残余尿量、最大尿流率),对所测指标行统计学分析。结果术前两组一般情况(年龄、前列腺大小、合并症情况等)比较,差异无统计学意义(P>0.05);PKRP组、PKEP组术中出血量、手术时间、术后平均膀胱冲洗时间、置管时间和住院时间分别为(180.5±15.2)和(110.3±14.8)ml、(95.1±4.5)和(70.4±4.6)min、(3.6±1.5)和(3.0±1.4)d、(5.1±1.0)和(4.4±0.7)d、(7.5±1.4)和(6.2±1.5)d,以上指标PKEP组明显少于PKRP组(P<0.05),切除前列腺重量PKEP组[(60.5±3.4)g]明显多于PKRP组[(54.0±3.6)g],术后1年两组患者残余尿量、最大尿流率均比术前明显改善(P<0.05)。结论 PKEP治疗BPH具有与PKRP相近的近期疗效,而患者术中并发症发生率、恢复时间PKEP组明显少于PKRP组,PKEP可安全、有效治疗BPH,可作为手术治疗BPH的一种选择。

Objective To compare the clinical efficacy and safety of transurethral plasmakinet-ic enucleation of prostate （PKEP）and transurethral plasmakinetic resection of prostate （PKRP）in the treatment of degree Ⅳ benign prostatic hyperplasia （BPH）. Methods 100 patients with degree Ⅳ BPH who had surgical indications were randomized into two groups：PKEP group and PKRP group.The preoperative international prostate symptom score （IPSS）,the quality of life,post-void residual urine volume （PVR）,quantity of maximum flow rate （Qmax）,the operation time,blood loss,weight of prostate,mean catheterization time,and hospitalization time were compared.Pa-tients were followed up one year after the operation and IPSS,PVR and Qmax were observed. Results There was no significant difference in preoperative factors between the two groups （P 〉0.05）.The mean operation time （70.4±4.6 min vs 95.1 ±4.5 min）,bladder irrigating time （3.0±1.4 d vs 3.6 ± 1.5 d）,hemorrhage （1 10.3 ± 14.8 ml vs 180.5 ±1 5.2 ml）,catheterization time （4.4±0.7 d vs 5.1±1.0 d）and hospitalization time （6.2±1.5 d vs 7.5±1.4 d）were signifi-cantly less in the PKEP group than in the PKRP group （P ＆lt;0.05）.The mean resected tissues weighted more in the PKEP group （60.5±3.4 g）than in the PKRP group （54.0±3.6 g）（P ＆lt;0.05）.One year after operation,PVR and Qmax in both groups were improved singnificantly. Conclusions PKEP is as effective as PKRP for the treatment of symptomatic BPH.Transurethral PKEP is a safe,effec-tive surgical method to be chosen for the treatment of BPH.