经尿道前列腺电切术治疗大体积良性前列腺增生安全性及有效性的回顾性对照研究

Retrospective study of the safety and effectiveness of transurethral resection of the prostate for be-nigh prostatic hyperplasia in large prostates

目的 探讨经尿道前列腺电切术（TURP）治疗大体积（≥80 ml）良性前列腺增生（BPH）的安全性及有效性.方法 回顾性分析我院2010年1月至2013年1月采用TURP治疗的958例BPH患者的临床资料,根据前列腺大小分为大体积前列腺组（≥80 ml,A组）和中、小体积前列腺组（＜80 ml,B组）.对比研究两组TURP手术的安全性和有效性.结果 A组276例,B组682例,两组年龄、术前美国麻醉医师协会评分差异无统计学意义（P＞0.05）.A组术后血红蛋白及血清Na＋浓度降低较多、术中切除腺体较多、手术时间较长,与B组比较差异均有统计学意义（P＜0.01）,A、B两组围手术期并发症的改良外科手术并发症标准评级系统评分及术后留管时间、住院时间差异无统计学意义（P＞0.05）.术后6个月A组最大尿流率（Qmax）从术前的（5.9±2.9） ml/s增至（17.1±8.2）ml/s,B组从术前的（6.1±3.0） ml/s增至（17.5±6.4） ml/s;A组国际前列腺症状评分（IPSS）从术前的23.7±6.1降至5.9±4.9,B组从术前的23.1±5.5降至6.2±4.4,两组组内比较差异均有统计学意义（P＜0.01）.术后随访两组间IPSS、生命质量评分、Q.x、膀胱残余尿及远期并发症发生率差异均无统计学意义（P＞0.05）.结论 TURP治疗大体积BPH具有和治疗中、小体积BPH相似的安全性和有效性.

Objective To discuss the safety and effectiveness of transurethral resection of the prostate （TURP） on large-size （≥ 80 ml） benign prostatic hyperplasia （BPH）.Methods Retrospective analysis of 958 BPH patients in Southwest Hospital during January 2010 to January 2013 was conducted.The patients were grouped into ≥80 ml prostate group （Group A） and 〈80 ml prostate group （Group B） according to the volume of prostate.Comparison was made between the 2 groups on the safety and effectiveness of TURP.Results There were 276 patients in Group A and 682 in Group B.No significant differences were shown in average age and preoperative American society of anesthesiology score of Group A and B.Compared with Group B,decrement in hemoglobin level and blood Na＋ concentration of Group A was more significant （P〈0.01）.There were more prostate tissues excised and duration of the operations was longer （P〈0.01）.No significant difference was observed in peri-operative complications graded by the modified Clavien classification system,catheter durations and durations of hospital stay between the 2 groups （P〉0.05）.At 6 months after the surgery,average maximum urinary flow rate （Qmax） increased from 5.9±2.9 ml/s to 17.1±8.2 ml/s for Group A and 6.1±3.0 ml/s to 17.5±6.4 ml/s for Group B,both groups showed significant increase in Qmax after surgery（P〈0.01）.Six months after surgery,international prostate symptom score （IPSS） of Group A decreased from 23.7±6.1 to 5.9±4.9 while IPSS of Group B decreased from 23.1±5.5 to 6.2±4.4,both groups showed a significant decrease （P〈0.01）.No significant difference was shown in IPSS,quality of life,Qmax,postvoid residual urine volume and occurrence rate of long-term complications after 6 months between the 2 groups （P〉0.05）.Conclusion TURP is as safe and effective in treating large-size BPH as treating medium and small-size BPH.