刨削器在经尿道双极等离子体前列腺解剖性剜除术中的临床应用

Application of morcellator in transurethral bipolar plasmakinetic anatomical enucleation of the prostate

目的探讨刨削器在经尿道双极等离子体前列腺解剖性剜除术中的安全性和临床效果。方法搜集本院2015年1月~2015年7月收治因前列腺增生行经尿道双极等离子体前列腺解剖性剜除术的患者共47例,将术中使用刨削器粉碎剜除剥离的腺瘤并利用其负压吸引作用吸出的共29例患者(刨削器组)和术中使用双极电切袢按序将已剜除剥离的腺瘤快速、由浅入深的切碎、冲出的共18例患者(电切袢组)进行对比,记录腺瘤处理速度和并发症发生情况。结果手术均一次性成功,对比术中处理剜除剥离的腺瘤的时间和速度,刨削器组的速度为2.24±1.09 min和18.43±6.01 g/min,电切袢组的速度为17.19±11.74 min和1.91±0.65 g/min,两组间有明显差别。总手术时间刨削器组和电切袢组分别是28.13±14.71 min和43.22±25.39 min,两组间有差别。刨削器组和电切袢组的术后膀胱持续冲洗时间、术后留置尿管时间、术后住院天数分别是18.30±4.56 h、19.28±8.06 h、2.28±1.29、2.59±1.21、4.39±1.41、4.67±1.37 d,两组间无明显差别。结论在经尿道双极等离子体前列腺解剖性剜除术中使用刨削器处理剜除剥离的腺瘤是安全、可行的,能加快手术速度,提高工作效率,减少术者疲劳程度。刨削器具有显著的临床推广价值。

Objective To assess the safety and therapeutic effect of morcellator in transurethral bipolar plasmakinetic anatomical enucleation(TUPKAEP) of benign prostate hyperplasia(BPH). Methods The clinical data of 47 patients with BPH receiving TUPKAEP between January and July, 2015 were analyzed. During the operation, morcellator was used to smash the enucleated BPH which was aspirated with subatmospheric pressure in 29 cases, and the tissue was smashed with bipolar electrosurgical loop slicing from top to bottom and aspirated by ellic suction in 18 cases. Results The procedures were completed successfully in all the 47 cases. The time used for adenoma dissociation was 2.24±1.09 with morcellator at the speed of 18.43±6.01 g/min, and was 17.19 ± 11.74 min with bipolar electrosurgical loop at the speed of 1.91 ± 0.65 g/min; the mean total operation time was significantly shorter in morcellator group(28.13 ± 14.71 vs 43.22 ± 25.39 min). The 2 groups showed no significant difference in postoperative continuous bladder irrigation time, postoperative indwelling time of urinary catheter or postoperative hospital stay. Conclusions Morcellator is safe and feasible for application in TUPKAEP and helps to shorten the operation time.