TUERP术与TURP术治疗对良性前列腺增生患者尿道功能、性生活质量及术后并发症的影响

Effects of TUERPand TURP on the urethral function, quality of sexual life and postoperative complications in patients with benign prostatic hyperplasia

目的探究经尿道前列腺剥除术(TUERP)与经尿道前列腺电切术(TURP)治疗对良性前列腺增生(BPH)患者尿道功能、性生活质量及术后并发症的影响。方法选取2015年3月至2017年3月武汉科技大学附属天佑医院诊治的174例BPH患者作为研究对象。随机数表法分为观察组与对照组各87例。观察组患者行TUERP治疗,对照组患者则行TURP治疗。观察术前、术后3d和术后7d时,两组患者炎症应激指标[白细胞介素-6(IL-6)、内皮素-1(ET-1)]变化,比较术前及术后6个月时,两组患者尿道功能指标[最大尿流率(Q_(max))、残余尿量(RUV)、达到Q_(max)时的逼尿肌压(Pdet_(Qmax))]、性生活质量[国际勃起功能问卷-5(IIEF-5)、性生活质量调查量表-生活质量维度(SLQQ-QOL)]改变情况,分析两组患者围术期基本情况(手术时间、术中出血量、膀胱冲洗时间、导尿管留置时间和术后住院时间)及术后6个月内并发症、BPH复发发生情况差异。结果术后3d、7d时,两组患者血清IL-6、ET-1水平均较术前有显著提升,且观察组明显低于同期对照组,差异具有统计学意义(均P<0.05)。术后6个月时,两组患者Q_(max)水平均较术前有显著提升,而RUV、Pdet_(Qmax)水平则均较术前有显著下降,差异具有统计学意义(均P<0.05),但组间比较无统计学意义(均P>0.05);观察组患者IIEF-5、SLQQ-QOL评分均较术前无明显变化,差异无统计学意义(均P>0.05),但明显高于同期对照组,差异具有统计学意义(均P<0.05)。观察组患者手术时间、术中出血量、膀胱冲洗时间、导尿管留置时间和术后住院时间均明显少于对照组,差异具有统计学意义(均P<0.05)。术后6个月内,观察组患者并发症发生率及BPH复发率均明显低于对照组,差异具有统计学意义(均P<0.05)。结论 TUERP与TURP应用于治疗BHP均可有效提升患者尿道功能,其中TUERP对其性生活质量影响程度较低,且术后并发症发生风险较小,有利于患者预后恢复。

ObjectiveTo investigate the effects of transurethral enucleative resection of prostate(TUERP) and transurethral resection of the prostate (TURP) on the urethral function, quality of sexual life and postoperative complications in patients with benign prostatic hyperplasia (BPH). Methods174 BPH patients treated in our hospital were selected and were divided into the observation group (n=87) and the control group (n=87). The observation group was treated with TUERP, and the control group was treated with TURP. The changes in inflammatory stress indexes [interleukin-6 (IL-6) and endothelin-1 (ET-1)] in the two groups were observed before operation, at 3 d and 7 d after operation. The urethral function indexes [maximum urinary flow rate (Qmax), residual urine volume (RUV), detrusor pressure at Qmax (PdetQmax)], quality of sexual life [International index of erectile function-5 (IIEF-5), sexual life quality questionnaire-quality of life dimension (SLQQ-QOL)] were compared before operation and at 6 months after operation. The basic situation in perioperative period (operative time, intraoperative blood loss, bladder washing time, urinary catheter retention time, postoperative hospital stay), complications and BPH recurrence within 6 months after operation were analyzed in the two groups. ResultsAt 3 days and 7 days after operation, the levels of serum IL-6 and ET-1 were significantly increased in the two groups compared with those before operation, and the levels in the observation group were significantly lower than those in the control group at the same time period, with statistically significant differences (all P<0.05). At 6 months after operation, the Qmax level in the two groups was increased significantly compared with that before operation while the levels of RUV and PdetQmax were decreased significantly (all P<0.05), but there was no significant difference between the two groups (all P>0.05). The scores of IIEF-5 and SLQQ-QOL in the observation group were not significantly different from those before operation (all P>0.05), but were significantly higher than those in the control group (all P<0.05). The operative time, intraoperative blood loss, bladder washing time, urinary catheter retention time and postoperative hospital stay in the observation group were significantly less than those in the control group, with statistically significant differences (all P<0.05). Within 6 months after operation, the incidence of complications and the BPH recurrence rate in the observation group were significantly lower than those in the control group (all P<0.05). ConclusionsTUERP and TURP can effectively improve the urethral function of patients with BPH, and TUERP has little impact on the quality of sexual life with low risk of postoperative complications, which is conducive to prognosis recovery.