经尿道等离子双极电切治疗高龄高危前列腺增生症

Treatment of high-risk patients with benign prostatic hyperplasia by transurethral plasma bipolar resection

目的总结经尿道等离子双极电切治疗高龄高危前列腺增生症患者的经验和观察其临床疗效。方法回顾分析我科于2015年1月~2017年6月采用经尿道等离子双极电切术,治疗60例高龄高危前列腺增生症的临床资料,记录术前患者的PSA、IPSS、QOL,统计手术时间、出血量、并发症发生率、术后住院时间等资料。结果本组60例患者均顺利完成,平均手术时间103±32.3 min,平均出血量62.6±34.4 mL,无输血,术后平均住院时间平均7.4±1.1 d。术后3月Qmax 19.8~26.3 mL/s,平均23.2±1.7 mL/s;IPSS 6~17分,平均11.6±2.5分;QOL 0~3分,平均1.26±0.78分,与术前相比差异有统计学意义,t值分别为31.1、29.5、36.6,所有P<0.001。术后5例出现暂时性尿失禁,1例发生术后尿道狭窄,经对症处理情况改善后出院。平均随访15.68±7.32月,均未出现尿潴留,排尿畅。结论经尿道等离子双极电切治疗高龄高危前列腺增生症患者是安全的、有效的。

Objective To summarize the experience and record the clinical efficacy of transurethral plasma bipolar resection in the treatment of elderly patients with high risk of benign prostatic hyperplasia. Methods From January 2015 to June 2017,60 consecutive patients with symptomatic obstructive BPH were treated with transurethral plasmakinetic resection prostate. Preoperative and postoperative parameters were recorded and evaluated including International Prostate Symptom Score questionnaire（IPSS）,maximum urinary flow rates（Qmax）,prostate volume（assessed by transrectal ultrasound）,postvoid residual urine volume（PRV）measurement and Quality of life score（Qo L）. The operation time and complications were also recorded. Results Median follow-up was 15.68 ± 7.32 months. There were statistically significant differences between baseline and postoperative parameters.Mean Qmax increased from 5.6±4.2 ml/s to 23.2±1.7 ml/s（P〈0.001）. Their mean IPSS improved from22.3±5.6 to 11.6±2.5（P〈0.001）and mean QOL improved from 5.01±0.43 to 1.26±0.78（P〈0.001）.Urethral stricture developed in 1.6% of patients,respectively. No patient had recurrent BPH symptoms except one case of urethral stricture associated surgery needed further treatment. Conclusion Transurethral plasma bipolar resection of the prostate is a safe and effective treatment for patients with high risk of benign prostatic hyperplasia.