经尿道前列腺电切术对前列腺增生患者尿道狭窄及性功能的影响研究

Impact of transurethral resection on the urethral stricture and sexual function of patients with prostate hyperplasia

目的:探讨经尿道前列腺电切术对前列腺增生患者尿道狭窄及性功能的影响。方法:76例前列腺增生患者根据治疗方法不同分为观察组和对照组各38例,观察组采用经尿道前列腺电切术,对照组行传统开放性手术,其中20例行SPP术及18例行Madigan术。比较两组患者术中出血量、术后膀胱冲洗时间、留置尿管时间、平均输血量、住院时间及术前术后IPSS、QOL、Qmax的变化,及两组患者术后9个月勃起功能障碍发生率、逆行射精发生率、并发症情况。结果:观察组患者的术中出血量、平均输血量明显少于对照组,观察组患者留置尿管时间、术后膀胱冲洗时间、住院时间分别短于对照组(P<0.05)。术后3个月复查,观察组患者的IPSS较对照组降低更显著,观察组患者的QOL评分、Qmax较对照组升高更显著(P<0.05)。观察组术后9个月勃起功能障碍发生率为44.7%(17/38),对照组SPP术术后9个月勃起功能障碍发生率为45.0%(9/20),对照组Madigan术术后9个月勃起功能障碍发生率为33.3%(6/18),组间比较差异统计学意义(P>0.05)。观察组术后逆行射精发生率为55.3%(21/38),对照组SPP术术后逆行射精发生率为45%(9/20),对照组Madigan术术后逆行射精发生率为11.1%(2/18),组间比较差异具有统计学意义(P<0.05)。且对照组Madigan术术后逆行射精发生率明显低于观察组和对照组SPP术组(P<0.05)。观察组并发症总发生率达10.5%,明显低于对照组(P<0.05)。观察组尿道狭窄发生率2.6%,明显低于对照组(13.2%)(P<0.05)。结论:经尿道前列腺电切术对前列腺增生疗效确切,具有出血少、并发症少、尿道狭窄发生率低等优点,但其与开发性手术对性功能的影响差异不大,且开放性手术中Madigan术式较TURP更具优势,其逆行射精的发生率明显低于TURP,说明TURP对术后射精功能有较大影响。

Objectives： To investigate the impact of transurethral resection on the urethral stricture and sexual function of patients with prostate hyperplasia. Method： 76 patients with prostate hyperplasia were randomly divided into observation group and control group,each with 38 patients. Transurethral resection was used for observation group,while traditional open surgery for control group,including 20 patients undertaking SPP surgery and Madigan surgery for 18 patients. The intraoperative blood loss,postoperative indwelling catheter time,catheterization time,average amount of blood transfusion,hospitalization time and preoperative and postoperative IPSS,QOL, Qmax changes,as well as the incidence of erectile dysfunction barriers,retrograde ejaculation and complications were compared nine months after surgery. Results： The intraoperative blood loss and average amount of blood transfusion of the observation group were significantly less than the control group,and indwelling catheter time,postoperative bladder irrigation,hospitalization time were shorter than the control group（ P〈0. 05）. In the reexamination three months after the surgery,the decrease of IPSS and increase of QOL score and Qmax in the observation group were more significant than the control group（ P〈0. 05）. The incidence of erectile dysfunction in the observation group,SPP control group and Madigan control group nine months after the surgery were 44. 7%（ 17 /38）,45. 0%（ 9/20） and 33. 3%（ 6/18） respectively; the difference between groups was not statistically significant（ P〉0. 05）. The incidence of postoperative retrograde ejaculation in the observation group,SPP control group andMadigan control group were 55. 3%（ 21 /38）,45%（ 9 /20） and 11. 1%（ 2 /18） respectively; the difference between groups was of statistical significance（ P〈0. 05）. Moreover,the incidence of postoperative retrograde ejaculation in the Madigan control group was obvious lower than the observation group and SPP control group（ P〈0. 05）. The overall incidence of complications was 10. 5% in the observation group,significantly lower than the control group（ P〈0. 05）; the incidence of urethral stricture in the observation group was 2. 6%,significantly lower than the control group（ 13. 2%）（ P〈0. 05）. Conclusion： Transurethral resection is effective for prostate hyperplasia, with advantages such as less bleeding,fewer complications,low incidence of urethral stricture,and etc,but its effect for sexual function is of no significant difference from open surgery. Among open surgeries,Madigan surgery is of more advantages compared with TURP,for the incidence of retrograde ejaculation is significantly lower,which demonstrates that TURP exerts a greater impact on postoperative ejaculatory function.