经尿道等离子前列腺剜除术与电切术治疗前列腺增生的疗效分析

Comparison of transurethral enucleation and resection of the prostate with bipolar plasmakinetic electrode for benign prostatic hyperplasia in basic-level hospitals

目的比较经尿道等离子前列腺剜除术(TUERP)和等离子前列腺电切术(PKRP)治疗前列腺增生患者的临床疗效,为基层医院前列腺增生的手术方式的选择提供参考。方法选取自2014年9月到2016年9月期间我院泌尿外科收治的前列腺增生患者68例,将患者随机分为TUERP组34例和PKRP组34例。分析两组手术时间、术中出血量、切除组织量、有无包膜穿孔以及术后3个月的国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Qmax)等指标。结果与PKRP相比,TUERP手术时间更短,出血量更少,包膜穿孔例数少,切除组织量多、术后冲洗时间更短(P<0.05)。此外,TUERP组无输血病例,PKRP组有1例患者由于出血严重而输注2个单位的红细胞悬液。术后随访3个月,我们发现两组患者术后3个月的PVR、Qmax、IPSS、QOL均较术前有明显改善(P<0.05),术后3个月两组间PVR、Qmax、IPSS、QOL差异无统计学意义(P>0.05)。结论 TUERP近期手术疗效不差于PKRP术,但与PKRP术相比,切除组织更完全,出血量少,手术时间更短,值得在基层医院推广应用。远期效果仍有待长期随访的大样本随机对照研究进一步证实。

Objective To compare the clinical efficacy of transurethral enucleation and resection of the prostate with bipolar plasmakinetic electrode for benign prostatic hyperplasia（BPH）. MethodsFrom September 2014 to September 2016 in our hospital, 68 patients with hyperplasia of prostate were collected and randomly divided into transurethral enucleative resection of the prosstate（TUERP） group,（34 cases） and plasmakinetic resection of the prostate（PKRP） group,（34 cases）. The operation time, blood loss, amount of tissue removed, presence of capsular perforation in two groups were collected and analyzed. Furthermore, the prostate symptom score（IPSS）, quality of life score（QOL）, residual urine volume（PVR）, and other indicators at 3 months postoperative were analyzed. Results Compared with PKRP group, shorter operation time, less blood loss, less capsular perforation cases, more resection of organizational capacity and shorter flush time were shown in TUERP group（all P〈0.05）. In addition, there was no blood transfusion in TUERP group cases, but 1 patient in PKRP group needed two units of red blood cell transfusion due to severe bleeding. Three months after operation PVR, Qmax, IPSS, QOL of postoperative patients were significantly better than that in preoperative patients（all P〈0.05）, But there were no difference of PVR, Qmax, IPSS, QOL between the two groups of patients 3 months later. Conclusion The clinical efficacy of TUERP group was similar to PKRP group. However, compared with PKRP group, more resection of organizational capacity, less blood loss and shorter operation time were shown in TUERP group, which worthy of popularization and application in grassroots hospital. But its long-term effect remains to make sure via randomized controlled studies in larger samples.