腔内整体剜除加耻骨上穿刺气膀胱下旋切在大体积前列腺增生治疗中的应用

Transurethral enucleation plus pneumo-cystostomy rotary cut for large benign prostatic hyperplasia

目的:探讨经尿道腔内整体剜除加耻骨上穿刺气膀胱下旋切治疗大体积BPH的可行性、有效性和实用性。方法:应用尿道腔内整体剜除加耻骨上穿刺气膀胱下旋切治疗大体积BPH 26例,年龄62～85岁,前列腺体积80～165 ml。术中先用等离子电切环及镜鞘沿前列腺包膜剥离增生腺体,完整剜除后推入膀胱,前列腺窝彻底止血。耻骨上穿刺膀胱,插入旋切器,连接气腹机,在气膀胱下钳夹剜除的腺体,旋切成条状标本取出。结果:所有患者均顺利完成手术。手术时间32～54 min,平均41 min,术中出血量均少于60 ml。1例术后2 d内轻度水外渗,2例有轻微膀胱刺激征,术后2～4 d拔除膀胱造瘘管,6～9 d拔除导尿管。2例暂时性尿失禁,3～20 d后消失;23例获2～8个月随访。8例有射精史患者,均逆行射精,无尿道狭窄和其他并发症。手术前后国际前列腺症状评分(IPSS)[(26.2±2.4)分vs(6.5±2.2)分]、生活质量评分(QOL)[(4.6±1.2)分vs(1.4±0.9)分]、最大尿流率(Qmax)[(5.8±1.0)ml/s vs(19.6±2.8)ml/s]比较差异均有统计学意义(P均﹤0.01)。结论:经尿道腔内整体剜除加膀胱穿刺旋切治疗大体积BPH可行,可缩短手术时间,安全而有效。

Objective： To investigate the feasibility, effectiveness and practicability of transurethral enucleation plus pneumo- cystostomy rotary cut （ TUE ＋ PCRC） for large benign prostatic hyperplasia （BPH）. Methods ： We performed TUE ＋ PCRC for 26 BPH patients aged 62 - 85 years with the prostate volume of 80 - 165 ml. We conducted transurethral enucleation of the hyperplastic prostate glands and pushed them into the bladder, followed by bladder puncture for pneumo-cystostomy rotary cut. Results： All the surgical procedures were successfully accomplished, with the mean surgical time of 41 （32 -54） minutes and intraoperative blood loss 〈 60 ml in all the cases. Twenty-three of the patients were followed up for 2 - 8 months, which revealed no stricture of the urethra or any other severe complications. Compared with the preoperative baseline, significant improvement was achieved in the IPSS （6.5 ± 2.2 vs 26.2 ±2.4）, QOL （ 1.4 ±0.9 vs 4.6 -＋ 1.2） and Qmax （ [5.8 ± 1. 0] vs [ 19.6 ±2.8] mE/s） of the patients after surgery （ P 〈 0. 01 ）. Conclusion ： TUE ＋ PCRC, with its advantages of short operation time and less severe complications, is a safe and effective approach to the management of large BPH.