三种微创术式治疗重度良性前列腺增生症有效性和安全性评价

Clinical efficacy and safety of three kinds of transurethral operation for benign prostatic hypertrophy

目的:探究选择性绿激光汽化术(PVP)、等离子剜除术(PKEP)和经尿道前列腺电切术(TURP)三种术式治疗重度良性前列腺增生症(BPH)的效果和并发症。方法:283例BPH患者随机被分成三组,PVP组93例,PKEP组96例,TURP组94例,比较三组手术时间、住院时间、留置导尿管时间、术中出血量、术后出血率,国际前列腺症状评分(IPSS)、最大尿流率(Q_(max))及术后并发症。结果:和手术前相比,三组术后IPSS、生活质量评分(QOL)、最大尿流率(Q_(max))、残余尿量(RUV)均显著好转。组间差异无统计学意义。PVP组失血量、术后失血率及输血率、膀胱冲洗天数、保留尿管天数和住院时间明显少于其他两组,PVP组近期并发症发生率明显小于其余两组,TURP组尿道狭窄及电切综合征的发生率比其他两组高。PKEP组手术时间最短。结论:PVP及PKEP具有手术时间更短、创伤小、出血更少、恢复更快、并发症发生率低等特点,是治疗重度前列腺增生的新方法。

Objectives： To compare the clinical efficacy and complications of transurethral resection of the prostate （TURP）, photoselective vaporization of prostate （PVP） and transurethral plasmakinetic enucleation of the prostate （PKEP） for benign prostatic hypertrophy （BPH）. Methods： A total of 283 patients with BPH were randomly divided into three groups： 93 cases underwent PVP; 96 cases underwent PKEP and 94 cases underwent TURP. The three groups were compared in operation time, hospitalization time, indwelling guide catheter time, intraoperative bleeding volume, postoperative bleeding rate, International Prostate Symptom Score （ IPSS）, maximal urinary flow rate （Qmax） and postoperative complications. Results： Compared with the preoperative results, the IPSS, the quality of life score （QOL）, Qmax and the residual urine volume （RUV） of the three groups were significantly improved, without significant difference. In terms of the amount of bleeding, postoperative hemorrhage rate, intraoperative blood transfusion volume, bladder irrigation time, retention catheter time and hospitalization time, PVP group was obviously less than that of the other two groups. The short - term complication rate of PVP group was significantly lower than that in the other two groups. Urethral stricture and electric cutting syndrome rate of TURP group was higher than the other two groups. The operation time of PKEP group was the shortest. Conclusion ： PVP and PKEP are characterized by less operative time, less trauma, less bleeding, quicker recovery and lower compli- cation rate, which is a new treatment for severe prostatic hyperplasia.