经尿道前列腺电切术10年变迁

The changing practice of transurethral resection of the prostate in recent 10 years

目的探讨经尿道前列腺电切术（TURP）近10年的变迁。方法回顾性分析2004年、2009年、2013年于北京大学人民医院泌尿外科行经尿道前列腺电切术的患者303例。结果患者的年龄、术前平均前列腺特异抗原（PSA）、国际前列腺症状评分（IPSS）、生活质量评分（QOL）差异无统计学意义（P〉0.05）。2004年患者平均前列腺体积61.48（19.09~174.68）mL,2009年增加到69.01（17.42~222.94）mL,2013年增加到77.25（12.63~292.49）mL,差异有统计学意义（P〈0.05）,最大尿率有显著的下降（P〈0.05）。合并膀胱结石的患者由2004年的6.3%,增加到2013年的15.0%,差异具有统计学意义（P〈0.05）。2004年平均手术时间（70.07±28.61）min,2013年增加到（93.70±42.18）min。而术中失血量近年来有明显的下降（P〈0.05）。膀胱冲洗时间以及留置尿管时间有显著缩短（P〈0.05）。结论目前,TURP的手术量在逐渐减少,更多的因为BPH并发症而行手术干预。手术患者的前列腺体积越来越大,手术时间虽有延长,但手术相关早期并发症的发生率并没有增加。

Objective To investigate the changes in transurethral resection of prostate（TURP）in the past 10 years.Methods A retrospective analysis was conducted in303 patients who underwent TURP in the year 2004,2009 and2013.Results There was no significant difference among the three years in patients＇ age,preoperative PSA,IPSS and QOL（P0.05）.In 2004,the mean prostate volume of patients undergoing TURP was 61.48 mL（ranged 19.09-174.68 mL）.which increased to 69.01 mL by 2009（ranged 17.42-222.94 mL）,and to 77.25 mL by 2013（ranged 12.63-292.49 mL）.There was a statistically significant increase（P0.05）.Meanwhile,a significant decrease was found in the Qmax（P0.05）.Over the 10-year study period,the number of patients with bladder stone combined with BPH requiring TURP increased from6.3%to 15.0%（P0.05）.The mean‘in-theatre＇time in 2004was（70.07±28.61）min,rising to（93.70±42.18）min in 2013（P0.05）.However,the mean intra-operative blood loss was significantly reduced.The mean bladder irrigation time and in-dwelling urethral catheter time was decreased（P0.05）.Conclusions The number of TURP performed is in decline.More patients received TURP as a result of complications arising from prostatic obstruction than that of 10 years ago.The‘in-theatre＇time is increased,because of the larger size of prostate.But the incidence of postoperative complications is not increased.