经尿道前列腺等离子剜除术与耻骨上前列腺切除术治疗大前列腺(>100g)的前瞻性研究

Prospective study of transurethral plasma kinetic enucleation of prostate versus suprapubic prostatectomy for benign prostatic hyperplasia greater than 100 grams

目的:比较经尿道前列腺等离子剜除术(TPKEP)与耻骨上经膀胱前列腺切除术(OP)治疗大前列腺(>100g)的临床疗效。方法:选取2010年1月~2015年6月在我院住院接受手术治疗的、前列腺超过100g的120例良性前列腺增生(BPH)患者,随机纳入TPKEP组和OP组,每组各60例,分别统计对比两组患者的手术时间、术中出血量、手术切除前列腺腺体质量、术后保留导尿时间、膀胱冲洗时间、住院时间、术后6个月IPSS、Q_(max)、QOL、PVR的变化及术后6个月内并发症发生率。结果:两组患者均成功实施手术治疗。TPKEP组比OP组手术时间短、手术出血量少[(90.6±19.5)min vs.(120.0±18.7)min;(54.7±10.7)ml vs.(80.5±15.7)ml],差异有统计学意义(P<0.05);手术切除腺体质量[(TPKEP组(83.3±21.6)g vs.OP组(86.7±23.2)g],两组差异无统计学意义(P>0.05);TPKEP组比OP组术后保留导尿及住院时间短[(145.8±16.3)h vs.(192.3±12.1)h;(6.2±0.7)d vs.(8.6±2.5)d],两组差异有统计学意义(P<0.05);术后膀胱冲洗时间[TP〗,两组差异无统计学意义(P>0.05);术后随访6个月,两组患者的IPSS,Q_(max)、QOL、PVR均得到明显改善,两组差异无统计学意义(P>0.05);术后6个月内TPKEP组的总并发症发生率低于OP组(4.7%vs.6.5%),差异有统计学意义(P<0.05)。结论:TPKEP在治疗大前列腺上具有与耻骨上经膀胱前列腺切除术相似的近期疗效,相比之下,TPKEP具有手术时间更短,手术创伤及出血量更少,恢复更快,并发症发生率更低等优点,临床推广应用价值高,很可能成为传统开放手术治疗大前列腺增生的常规替代方法之一。

Objective： To compare the clinical effect between transurethral plasma kinetic enucleation of prostate （TPKEP） and suprapubic prostatectomy for benign prostatic hyperplasia （BPH） greater than 100 grams. Method： From January, 2010 to June, 2015, 120 cases of BPH greater than 100g in our hospital were randomly assigned to either TPKEP or OP surgery type, and each group included 60 patients. Perioperative and follow-up characteristics were recorded and compared, including operative time, blood loss, resection weights, catheterization time, bladder irrigation time, hospital stay, complications, IPSS, Q QOL and PVR. Result： All cases were operated successfully. Shorter operative time, less blood loss, shorter catheterization time and hospital stay were recorded in TPKEP group than those of OP group [ （90.6±19.5） rain vs. （120.0±18. 7） rain; （54. 7± 10.7） mlvs. （80.5±15.7） ml; （145.8±16.3） hvs. （192.3±12.1） hl （6.2±0.7） dvs. （8.6±2.5） d; P〈 0. 051. There was no significant difference in terms of resection weights and bladder irrigation time [ （83.3±21.6） gvs. （86.7±23.2） g; （45.3±10.7） h vs. （50.1±9.8） h; P〈0.05]. During six months of follow up period, there were obvious improvement in IPSS, Q QOL and PVR, but no significant differnce between two groups. And less complications were recorded in TPKEP group than that of OP group （4.7% vs. 6.5%, P〈 0.05）. Conclusion： TPKEP and OP are equally effective in short-term outcomes for removal of large prostatic adenomas. Compared with OP, TPKEP is accompanied by shorter operative time, less blood loss, minimal invasion,shorter recovery time and less complications. TPKEP may become one of the endourological alternative to open prostatectomy.