经尿道等离子双极和经膀胱前列腺摘除术治疗大体积良性前列腺增生的临床疗效比较

Effectiveness analysis of transurethral plasmakinetic resection of prostate and transvesical prostatectomy in the treatment of large prostate gland

目的：比较经尿道等离子双极前列腺切除（PKRP）和经膀胱前列腺摘除术（TVP）治疗大体积（＞80g）良性前列腺增生（BPH）患者的临床疗效。方法回顾性分析我院泌尿外科2010年6月至2013年6月采用PKRP或TVP治疗大体积良性前列腺增生87例患者的临床资料，比较两组术式患者围手术期一般资料及术后的随访结果等指标。结果两组患者术前一般资料、术中出血量和术后患者对排尿症状改善的满意度评分等资料差异无统计学意义。围手术期相关资料对比研究表明，TVP组在手术时间及切除组织体积等方面要优于PKRP组，PKRP组术后膀胱冲洗时间及住院时间较TVP组显著减少。术者对手术的满意程度调查结果表明，TVP术式的满意度显著优于PKRP术式。术后3、6个月时两组患者最大尿流率、生活质量评分以及IPSS评分等指标均较术前有显著改善，且术后6个月TVP组患者最大尿流率和IPSS评分明显优于PKRP组。结论对于大体积前列腺患者而言，PKRP和TVP手术各有优缺点，最终的术式选择需根据患者的个体化差异和手术者对不同术式的手术技巧差异和熟悉程度等多方面来考虑。

Objective To comparatively analyzeclinical efficacy and safety of transurethral plasmakinetic resection of prostate （PKRP） and transvesical prostatectomy （TVP） in the treatment of high volume of benign prostatic hyperplasia（＆gt;80g）. Methods Clinical data of 87 patients with high volume of benign prostatic hyperplasi who underwent PKRP or TVP from January 2010 to January 2013 in our hospital were retrospectively analyzed. Perioperative characteristics and postoperative 3-and 6-month International Prostate Symptom Score （IPSS）, maximal flow rate （Qmax）, quality of life （QoL）, and post-void residual urine volume （PUV） were documented, the degree of operator’s satisfaction to operation precedure and patient’ satisfaction to post-operation voiding improvement were also evaluated. Results There were no statistic differences in preoperative characteristics, intraoperative blood loss and the degree of patient’ satisfaction to post-operation voiding improvement between two groups. Compared with that of group TVP, postoperative bladder washing time and hospitalization time of patients in group PKRP were significantly decreased , but TVP was better than PKRP in resected tissue volume and the operator to the satisfaction of the operation procedure. Postoperative 3 and 6-month IPSS, QoL, Qmax and PUV were all improved significantly in two groups, and TVP showed great advantage over PKRP in Qmax and IPSS. Conclusion For the treatment of high volume of benign prostatic hyperplasia, different prostatectomy methods have their merits and demerits. The final treatment decision depends on personalized charateristic of patients and the surgeon’s advice, as well as proficiency of prostatectomy procedure, etc.