保留部分前列腺前叶等离子剜除术治疗60ml以上前列腺增生症的尿控策略

Urinary control strategy for the treatment of prostate hyperplasia with over 60ml by plasma enucleation with partial anterior prostate preserved

目的探讨保留部分前列腺前叶等离子剜除术治疗60ml以上前列腺增生症的尿控策略和技巧。方法选择2015年6月至2016年12月延安大学附属医院泌尿外科诊治、因60ml以上前列腺增生症行住院前列腺剜除治疗的112例患者为研究对象并进行回顾性分析。根据选择的手术方式将112例患者分为改良组和剜除组,改良组62例患者,行经尿道保留部分前列腺前叶等离子剜除术;剜除组50例患者,行经尿道等离子前列腺剜除术。随访并比较两组患者术后1天、术后1周、术后2周、术后1个月和术后3个月尿失禁发生情况。结果两组患者均顺利完成手术,术后1天拔除尿管,改良组和剜除组尿失禁发生率为16.0%和34.0%;术后尿管拔除后1周尿失禁分别为8.0%和24.0%;术后尿管拔除后2周尿失禁分别为6.0%和14.0%;术后尿管拔除后1月尿失禁分别为4.0%和10.0%,两组间差异均有统计学意义(均P<0.05)。术后尿管拔除后3月尿失禁分别为0%和2.0%,两组间差异均无统计学意义(均P>0.05)。两组患者均未出现永久性尿失禁。术后3个月,两组患者最大尿流率均有明显改善:改良组[术前(6.18±1. 32)、术后(23. 91±7. 31)]和剜除组[术前(6. 13±1. 41)、术后(23. 89±3. 39),均P <0. 05]。结论保留部分前列腺前叶等离子剜除术治疗60ml以上前列腺增生症,有助于术后控尿功能的快速恢复,值得临床应用推广。

Objective To explore the urinary control strategies and techniques for the treatment of prostate hyperplasia over 60 ml by plasma enucleation with partial anterior prostate preserved. Methods 112 patients who were diagnosed with prostate hyperplasia over 60 ml and treated by plasma enucleation in the Urology Department of the Affiliated Hospital of Yan′an University from June 2015 to December 2016 were selected and the clinical data was retrospectively analyzed. According to the surgical methods received, the 112 patients were divided into the modified group and the enucleation group. The 62 patients in the modified group underwent plasma enucleation with partial anterior prostate preserved and the 50 patients in the enucleation group underwent transurethral resection of prostate by plasma enucleation. The incidence of urinary incontinence was compared between the two groups at a day, a week, 2 weeks, a month and 3 months after operation. Results The operation was successfully completed in both groups. The incidence of urinary incontinence in the modified group and the enucleated group was 16.0% and 34.0% respectively at a day after removal of the catheter, was 8.0% and 24.0% at a week after removal of the catheter, was 6.0% and 14.0% at 2 weeks after removal of the catheter and was 4.0% and 10.0% at a month after removal of the catheter, all with statistically significant differences(all P<0.05). The incidence of urinary incontinence was 0% and 2.0% in the modified group and the enucleated group at 3 months after removal of the catheter, without statistically significant difference between the two groups(all P>0.05). No permanent incontinence occurred in either group. At 3 months after surgery, the largest urine flow rates were significantly improved in the two groups, the modified group [preoperative(6.18±1.32) vs. postoperative(23.91±7.31)] and the enucleation group [preoperative(6.13±1.41) vs. postoperative(23.89±3.39), all P<0.05]. Conclusions Plasma enucleation with partial anterior prostate preserved is effective in the treatment of prostate hyperplasia over 60 ml, which is conductive to the rapid recovery of urinary control function and is worthy of clinical application.