3种术式治疗高危大体积前列腺增生的比较

A Comparison of Three Operations for Treating High Risk Large Volume Benign Prostatic Hyperplasia

目的比较耻骨上前列腺切除术（suprapubicprostatectomy，SP）、经尿道前列腺电切术（transurethralresectionoftheprostate，TURP）与经尿道前列腺剜除电切术（transurethralenucleationandresectionoftheprostate，TUERP）治疗高危大体积前列腺增生患者的临床疗效和安全性。方法回顾性分析我院2005年7月～2014年3月手术治疗137例高危大体积前列腺增生患者的临床资料，以手术时期先后分别行SP（n=41）、TURP（n=42）和TUERP术（n=54）。比较3组手术时间、术后住院时间、腺体切除重量、术中出血量及术后国际前列腺症状评分、生活质量评分和膀胱残余尿等指标，并记录不良事件发生情况。结果137例手术均成功。手术时间sP组〈TUERP组〈TURP组[（69．7±10．2）min vs．（80．9±16．6）min vs．（100．7±19．0）min，F=41．306，P=0．000]。腺体切除重量TUERP组和SP组〉TURP组[（93．7±21．9）gvs．（101．9±26．6）gvs．（80．0±18．5）g，F=10．107，P=0．000]。术中失血量TUERP组〈SP组和TURP组（F=6．017，P=0．003）。术后住院时间TUERP组和TURP组〈SP组[（8．6±1．1）dvs．（8．9±1．4）dvs．（13．1±2．8）d，F=80．727，P=0．000]。3组术后3个月国际前列腺症状评分、生活质量评分和膀胱残余尿等指标差异均无显著性（P〉0．05）。结论SP、TURP与TUERP治疗高危大体积前列腺增生均安全、有效。TUERP具有切除腺体彻底、手术时间短、出血少、术后恢复快的优点。

Objective To compare the efficacy and safety of suprapubic prostatectomy（ SP）,transurethral resection of the prostate（ TURP）,and transurethral enucleation and resection of the prostate（ TUERP） for high risk large volume benign prostatic hyperplasia（ BPH）. Methods A total of 137 high risk patients with large volume BPH who underwent operations in our hospital from July 2005 to March 2014 were divided into either SP group（ n = 41）,or TURP group（ n = 42）,or TUERP group（ n = 54）. The operation time,hospital stay after operation,weight of prostate removed,intraoperative blood loss,IPSS,QOL,and PVR were compared among the three groups. Adverse events were recorded. Results The operations were successfully completed in all the 137 cases. The operation time showed that SP TUERP TURP [（ 69. 7 ± 10. 2） min vs.（ 80. 9 ± 16. 6） min vs.（ 100. 7 ± 19. 0） min,F = 41. 306,P = 0. 000]. The weight of prostate removed showed TUERP and SP TURP [（ 93. 7 ± 21. 9） g vs.（ 101. 9 ± 26. 6） g vs.（ 80. 0 ± 18. 5） g,F = 10. 107,P = 0. 000]. The intraoperative blood loss showed TUERP SP and TURP（ F = 6. 017,P =0. 003）. The postoperative hospital stay showed TUERP and TURP SP [（ 8. 6 ± 1. 1） d vs.（ 8. 9 ± 1. 4） d vs.（ 13. 1 ± 2. 8） d,F = 80. 727,P = 0. 000]. There were no significant differences in IPSS,QOL,and PVR at 3 months after operation among the three groups（ P〈0. 05）. Conclusions All of the SP,TURP,and TUERP are safe and effect for the treatment of high risk patients with large volume BPH. TUERP has advantages of better gland removal rate,shorter operation time,less bleeding,and faster postoperative recovery.