铲状电极经尿道前列腺等离子剜除术与等离子切除术治疗BPH的临床比较

Shovel-shaped electrode transurethral plasmakinetic enucleation versus plasmakinetic resection of the prostate in the treatment of benign prostatic hyperplasia

目的:探讨铲状电极经尿道前列腺等离子剜除术(PKEP)与经尿道前列腺等离子切除术(PKRP)治疗良性前列腺增生(BPH)的疗效和安全性。方法:回顾性选取2016年6月至2017年1月收治的BPH患者78例,其中经铲状电极PKEP手术39例,经PKRP手术39例,对比分析两种手术方式的术后临床疗效及安全性。结果:在安全性方面,同PKRP组相比,PKEP组患者手术时间无显著差异[(69.3±8.8)min vs(72.2±7.9)min,P=0.126],术后血红蛋白丢失量显著低于PKRP组[(3.9±2.8)g/L vs(13.9±5.2)g/L,P<0.01],PKEP组患者术后膀胱冲洗时间[(12.5±1.2)h vs(43.4±2.8)h,P<0.01]和导尿管留置时间[(64.0±4.5)h vs(84.8±3.0)h,P<0.01]时间均明显缩短,住院时间显著减少[(3.1±0.3)d vs(5.5±0.4)d,P<0.01]。在临床疗效方面,同PKRP组相比,铲状电极PKEP组患者最大尿流率(Qmax)[(21.62±1.07)ml/s vs(21.03±0.96)ml/s,P=0.12],国际前列腺症状评分(IPSS)[(5.85±0.90)分vs(6.03±0.81)分,P=0.279],生活质量评分( QoL)[(2.0±0.73)分vs(2.28±0.72)分,P=0.09]和残余尿量(PVR)[(19.59±6.01)ml vs(20.21±5.16)ml,P=0.629]均无统计学差异,尿失禁等术后并发症也无明显差异。结论:铲状电极PKEP和PKRP术后疗效相似,但采用铲状电极PKEP治疗对BPH患者具有更好的安全性,前列腺组织切除更彻底,术后效果好,可显著减少患者住院时间,术中出血少,并提高患者生活质量,值得推广应用。

Objective： To compare the safety and effectiveness of shovel-shaped electrode transurethral plasmakinetic enuclea- tion of the prostate （PKEP） with those of plasmakinetie resection of the prostate （PKRP） in the treatment of benign prostatic hyperpla- sia （BPH）. Methods ： We retrospectively analyzed the clinical data about 78 BPH patients received in Shanghai Ninth Peopleg Hospital from June 2016 to January 2017, 39 treated by shovel-shaped electrode PKEP and the other 39 by PKRP. We observed the pa- tients for 6 months postoperatively and compared the effects and safety of the two surgical strategies. Results ： No statistically signifi- cant difference was observed between the PKEP and PKRP groups in the operation time （ [69.3 ± 8.8] vs [72.2 ± 7.9] rain, P = 0. 126）, but the former, as compared with the latter, showed a markedly less postoperative loss of hemoglobin （ [3.9 ±2.8] vs [13.9 ± 5.21 g/L, P 〈0.001） and shorter bladder irrigation time （[12.5 ±1.2] vs [43.4 ±2.8] h, P 〈0.00l）, catheter- ization time （[64.0 ±4.5] vs [84.8 ±3.0] h, P 〈0.001） and hospital stay （[3.1 ± 0.3] vs [5.5 ± 0.4] d, P 〈0.001）. There were no statistically significant differences between the PKEP and PKRP groups in the postoperative maximum urinary flow rate （Qnmx） （[21.62± 1.07] vs [21.03 ± 0.96] ml/s, P = 0.12）, International Prostate Symptoms Score （IPSS） （5.85 ± 0.90 vs6.03 ± 0.81, P = 0.279）, quality of life score （QoL） （2.0 ±0.73vs2.28 ± 0.72, P = 0.09）, postwfidresidualurinevol- ume （PVR） （ [ 19.59 ± 6.01 ] vs [20.21 ± 5.16] ml, P = 0. 629）, or the incidence rates of urinary incontinence （2.56% [ 1/39 ] vs 7.69% [ 3/39 ], P 〉 0.05 ） and other postoperative complications. Conclusion ： Both PKEP and PKRP are effective methods for the treatment of BPH, but PKEP is worthier of clinical recommendation for a better safety profile, more thorough removal of the prostate tissue, less blood loss, shorter hospital stay, and better improved quality of life of the patient.