腔内剜除联合耻骨上切口治疗大体积前列腺增生症

目的 探讨经尿道前列腺分区汽化剜除联合耻骨上切口取出治疗大体积前列腺增生症的疗效及安全性.方法 选择60例大体积前列腺增生症患者,先经尿道采用等离子纽扣式电极分区汽化剜除前列腺增生组织,剜落的前列腺组织置入膀胱,前列腺创面止血,再取耻骨上经膀胱切口取出前列腺组织及膀胱结石;随访时间2-12个月.结果 所有患者手术顺利.平均手术时间（60±14.6）min,平均切除前列腺组织重量（120±15.3）g;术后1d较术前血红蛋白浓度平均下降（3.0±0.5）g/L;术后无输血及再次手术止血病例;膀胱平均冲洗时间（20±7）h;平均留置造瘘管时间（3.1±0.9）d;平均留置耻骨后引流管时间（4.7±1.1）d;平均留置导尿管时间（7.0±1.3）d;未发生切口感染及裂开、尿漏情况.随访2-12个月,未发生真性尿失禁及尿道狭窄.结论 经尿道前列腺分区汽化剜除联合耻骨上切口取出治疗大体积前列腺增生症,是安全高效的手术方法,具有出血少、前列腺腺体完整取出的优点.

Objective To investigate the efficacy and safety of transurethral vapor enucleation of the prostate combined with suprapubic cystotomy for the treatment of large volume of benign prostatic hyperplasia.MethodsA total of 60 cases of patients with large volume of benign prostatic hyperplasia were selected in the study,transurethral zoning vaporization and enucleation of the prostate with plasma button electrode were performed firstly to resect benign prostatic hyperplasia,enucleated prostate tissues were then placed into the bladder,followed by wound hemostasis of the prostate. Subsequently,a suprapubic transvesical incision was adopted for the removal of prostate and vesical calculi. The follow-up time was 2-12 months.ResultsAll patients were operated successfully,and the average operation time was（60±14.6）min. Meanwhile,the mean weight of resected prostate tissue was（120±15.3）g;the average decrease of hemoglobin concentration one day after operation was（3.0±0.5）g/L compared with that before operation. There was no blood transfusion and reoperation cases after operation. The mean bladder irrigation time was（20±7）h, mean time of indwelling catheter was（3.1±0.9）d,mean time of indwelling drainage tube was（4.7±1.1）d,and mean time of indwelling urinary catheter was（7.0±1.3）d. There was no incision infection,dehiscence and urine leakage. Furthermore,no real urinary incontinence and urethral stricture were found after a follow-up period of 2-12 months.Conclusions Transurethral vapor enucleation of the prostate combined with suprapubic cystotomy is a safe and effective surgical method for the treatment of large volume of benign prostatic hyperplasia that offers some benefits including less bleeding and complete removal of prostate gland.