不同管径电切镜在经尿道前列腺电切术中的应用效果比较分析

Application of Resectoscopes of Different Diameters in Transurethral Resection of the Prostate(TURP)

目的分析不同管径电切镜对前列腺增生(BPH)患者行经尿道前列腺电切术(Transurethral Resection of the Prostate,TURP)的术中安全性及术后并发症情况。方法将495例前列腺增生患者分为三组,分别采用不同管径进行手术。A组用F24管径持续灌流式;B组用F24管径间断灌流式或附加膀胱穿刺造瘘;C组用F26.5管径持续灌流式行经尿道前列腺电切术。比较三组的手术时间、术中出血、TUR综合征、术后再手术止血、术后输血、尿道狭窄、尿失禁情况。结果平均手术时间、术中大出血、TUR综合征、再次手术止血、术后输血等指标A组与B组比较差异显著(P<0.05),A组好于B组;尿道狭窄、尿道外口切开情况A、B组与C组比较差异显著(P<0.05),A、B组优于C组。结论采用F24管径持续灌流式电切镜施行TURP术治疗前列腺增生,术中安全性优于间断灌流式及附加膀胱造瘘术式;术后尿道狭窄等并发症少于大口径电切镜,且术中一般无需做尿道外口切开,适宜国人TURP术中选用。

Objective To discuss the intraoperative safety and postoperative complications of transurethral resection of the prostate （TURP）with resectoscopes of different diameters in patients with prostatic hyperplasia. Methods 495 cases with prostatic hyperplasia were divided into 3 groups：group A, B and C;TURP was performed to cases in group A with resectoscope of the diameter F24 for con-tinuous perfusion, to cases in group B with resectoscope of the diameter F24 for intermittent perfusion or plus paracentetic cystostomy and to cases in group C with resectoscope of the diameter F26.5 for continuous perfusion;a comparative study among the 3 groups was made to the operation duration, the bleeding volume in operation, TUR syndrome, surgical hemostasis after operation, blood transfusion after operation, urethral stricture and urinary incontinence. Results The index of average operation duration, bleeding in operation, TUR syndrome, surgical hemostasis and blood transfusion after operation of the cases in group A were superior to those of the cases in group B, the difference was significant（P＆lt;0.05）;the index of urethral stricture and urethrostomy in group A and B were superior to those in group C, the difference was significant（P＆lt;0.05）. Conclusions Resectoscope of the diameter F24 for continuous perfusion in TURP for patients with prostatic hyperplasia is of superior safety to that for discontinuous perfusion or plus paracentetic cystostomy and the occur-rence of complication such as urethral stricture is lower than that with resectoscopes of bigger diameters, and urethrosctomy is unneces-sary in operation;it is suitable for the Chinese.