经尿道前列腺电切术和(或)汽化切除术治疗良性前列腺增生的临床经验

Clinical experience of transurethral resection of prostate and/or transurethral vaporization of prostate in the treatment of BPH

目的：探讨经尿道前列腺电切术（TURP）和经尿道前列腺汽化切除术（TUVP）单独或联合治疗BPH的安全性和疗效。方法：2009年6月~2012年6月采用TURP和/或TUVP治疗BPH患者376例,其中TURP组116例,TUVP组125例,TURP与TUVP联合组（联合组）135例。经直肠B超检查计算三组前列腺重量分别为（81.3±22.8）、（78.5±21.5）和（82.2±20.6）g。比较三组之间手术时间、术中出血量、切除组织量、术后并发症等指标,以对比手术安全性;比较术前及术后3个月的Qmax、剩余尿量（RUV）、国际前列腺症状评分（IPSS）、生活质量评分（QOL）等指标,以对比其临床疗效。结果：TURP组、TUVP组和联合组的手术成功率分别为98.3%（114/116）、98.4%（123/125）和99.3%（134/135）（P〉0.05）;平均手术时间分别为（43.2±12.4）min、（55.3±14.5）min和（47.4±13.1）min（P〈0.05）;平均出血量分别为（220.4±50.5）ml、（85.5±24.6）ml和（100.4±30.2）ml（P〈0.05）;平均切除组织质量分别为（49.2±11.3）g、（52.7±13.3）g和（50.4±12.6）g（P〉0.05）;经尿道前列腺电切综合征（TURS）发生率分别为2.6%（3/116）、0.8%（1/125）和0.7%（1/135）（P〈0.05）;术后暂时性尿失禁发生率分别为1.7%（2/116）、4.8%（6/125）和1.5%（2/135）（P〈0.05）;术后3个月尿道狭窄发生率分别为1.7%（2/116）、4.0%（5/125）和1.5%（2/135）（P〈0.05）。三组患者术后3个月的Q max均较术前明显增加（P〈0.05）,术后IPSS、QOL、RUV均较术前明显下降（P〈0.05）,三组之间各指标比较差异均无统计学意义（P〉0.05）。结论：TURP、TUVP单独或联合均为治疗BPH的有效方法,TURP联合TUVP治疗兼有两者的优点,切割速度快,止血彻底,安全高效,并发症少,是治疗BPH的更好选择。

Objective：To investigate the safety and clinical efficacy of transurethral resection of prostate（TURP）and/or transurethral vaporization of prostate（TUVP）in the treatment of BPH.Method：The clinical data of 376 cases of BPH from June 2009 to June 2012 were retrospectively analyzed.They were divided into three groups：group TURP（116cases）,group TUVP（125cases）and combined group of TURP and TUVP（135cases）.The mean prostate weights measured through transrectal ultrasonography in the three groups were（81.3±22.8）g,（78.5±21.5）g and（82.2±20.6）g,respectively.The safety of operations was compared through the clinical indexes of the operative time,intraoperative blood loss,resected prostate weights and postoperative complications.The clinical efficacy of operations were analyzed by the clinical indexes of Qmax,post-void residual urine volume（RUA）,IPSS,and Quality of Life（QOL）and so on.Result：The clinical data of TURP,TUVP and combined group were as follows：the success rates of operations were 98.3%（114/116）,98.4%（123/125）and99.3%（134/135）respectively（P 〉0.05）;and the average operation time was（43.2±12.4）min,（55.3±14.5）min and（47.4±13.1）min,respectively（P 〈0.05）;the mean intraoperative blood loss was（220.4±50.5）ml,（85.5±24.6）ml and（100.4±30.2）ml,respectively（P〈0.05）;the mean resected prostate weighs were（49.2±11.3）g,（52.7±13.3）g and（50.4±12.6）g,respectively（P 〉0.05）;the incidences of transurethral resection syndrome（TURS）were 2.6%（3/116）,0.8%（1/125）and 0.7%（1/135）,respectively（P〈0.05）;the incidences of temporary urinary incontinence were 1.7%（2/116）,4.8%（6/125）and 1.5%（2/135）,respectively（P〈0.05）;the incidences of urethral stricture within three postoperative months were 1.7%（2/116）,4.0%（5/125）and1.5%（2/135）,respectively（P〈0.05）.Comparedwithpreoperativecondition,Qmaxwas obviously increased and IPSS,RUV,QOL scores were significantly decreased after follow-up period of three months in the three groups（P〈0.05）.There were no significant differences in these parameters among the postoperative conditions of three groups（P〉0.05）.Conclusion：The surgical procedures of TURP and/or TUVP have similar clinical efficacy in the treatment of BPH.The combined treatment of TURP and TUVP has some advantages of both methods,including high speed cutting,meticulous hemostasis,safety and high efficiency,fewer complications and so on.Therefore,it is a better choice for BPH.