经尿道等离子双极电切术治疗体积>80mL良性前列腺增生45例

Effect of transuretheral plasmakinetic resection in the treatment of benign prostatic hyperplasia with the prostate volume more than 80 m L in 45 cases

目的：探讨经尿道前列腺等离子双极电切术治疗体积〉80 mL良性前列腺增生（ BPH）的安全性和有效性。方法：对体能代谢当量水平〉4的45例体积〉80 mL BPH患者应用经尿道前列腺等离子双极电切术治疗,术中监测中心静脉压,对中心静脉压升高〉3 cm H2 O或超过正常值者静脉推注呋塞米20~40 mg。统计手术时间,术前和术后血红蛋白、红细胞比容、血钠水平,术后3、6、12个月最大尿流率、国际前列腺症状评分及生话质量评分变化和并发症。结果：45例体积〉80 mL BPH患者手术均顺利,无中转开放手术,无术中输血病例,手术时间（92.56±29.69） min。术前和术后血钠、血红蛋白、红细胞比容均无明显变化（P〉0.05）,患者术后3、6、12个月最大尿流率、国际前列腺症状评分及生话质量评分较术前均有明显改善（P〈0.01）。结论：应用经尿道前列腺等离子双极电切术治疗体积〉80 mL BPH,只要体能代谢当量水平〉4、做好围手术期准备、术中监测中心静脉压,可以获得安全、有效的治疗结果。

Objective：To explore the safety and effectiveness of transuretheral plasmakinetic resection of prostate （ PKRP ） in the treatment of benign prostatic hyperplasia（ BPH） with the prostate volume more than 80 mL. Methods：Forty-five BPH cases with the prostate volume more than 80 mL and functional capacity more than 4 METs were treated with PKRP. The central venous pressure （ CVP） was monitored during the operation,the 20 to 40 mg of furosemide was intravenously administrated in the patients with CVP more than 3 cm H2 O or normal value. The operation time, the levels of pre- and post-operation hemoglobin, hematocrit and serum sodium,and the maximum flow rate（ Qmax） ,international prostate symptom score（ IPSS） ,quality of life（ QOL） and complication after 3,6 and 12 months of operation were analyzed. Results：The operations in 45 cases with the prostate volume more than 80 mL were successful,no case was transferred to open surgery and transfused. The operation time of patients was （ 92. 56 ± 29. 69 ） min. The differences of the levels of sodium, hemoglobin and hematocrit between before and after operation were statistically significant （ P 〉0. 05）. Compared with theses before operation,the Qmax,IPSS and QOL after 3,6 and 12 months of operation were significantly improved（P〈0. 01）. Conclusions：In the case of functional capacity more than 4 METs,getting perioperative ready and monitoring intraoperative central venous pressure, the PKRP in the treatment of BPH with the prostate volume more than 80 mL is safe and effective.