经尿道等离子前列腺剜除术治疗大体积前列腺增生的疗效

Effect of Transurethral Plasma Kinetic Enucleation of Prostate for Large-volume Prostatic Hyperplasia

目的探讨经尿道等离子前列腺剜除术(TPKEP)治疗大体积良性前列腺增生的疗效。方法收集2016年3月~2018年1月佳木斯市中心医院泌尿外科收治的大体积前列腺增生患者126例,根据治疗方法分为对照组(58例)和观察组(68例)。对照组采用经尿道等离子前列腺电切术(TPKRP)治疗,观察组采用TPKEP治疗,比较两组围手术期指标(手术时间、术中出血量、前列腺切除重量、膀胱冲洗时间、留置尿管时间、术后住院时间)及术前、术后3、12个月IPSS评分、QOL评分、最大尿流率(Qmax)、残余尿量(RUV)和术后并发症发生情况。结果观察组手术时间、术中出血量、前列腺切除重量均优于对照组[(75.12±38.18)min vs(90.50±45.66)min]、[(98.33±26.71)ml vs(117.32±34.70)ml]、[(53.82±8.05)g vs(41.80±6.77)g],差异有统计学意义(P<0.05);两组膀胱冲洗时间、尿管留置时间、术后住院时间比较,差异无统计学意义(P>0.05)。两组术后3、12个月IPSS评分、QOL评分较术前降低,Qmax较术前增高,RUV较术前减少,差异有统计学意义(P<0.05)。观察组术后3个月QOL评分高于对照组,RUV低于对照组,差异有统计学意义(P<0.05);两组术后3个月IPSS评分、Qmax比较,差异无统计学意义(P>0.05)。观察组术后12个月Qmax高于对照组,RUV低于对照组,差异有统计学意义(P<0.05);两组术后12个月IPSS评分、QOL评分比较,差异无统计学意义(P>0.05)。观察组术后3、12个月并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论TPKEP治疗大体积前列腺增生临床疗效确切,可有效缩短手术时间、减少术中出血量、收割更多的增生腺体组织,达到满意的排尿功能,有助于改善患者术后的生活质量,且并发症的发生率较低,具有较高的临床应用价值。

Objective To investigate the efficacy of transurethral plasma kinetic enucleation of prostate(TPKEP)for large-volume benign prostatic hyperplasia.Methods A total of 126 patients with large benign prostatic hyperplasia treated in the Urology Department of Jiamusi Central Hospital from March 2016 to January 2018 were collected and divided into the control group(58 cases)and the observation group(68 cases)according to the treatment method.The control group was treated with transurethral plasma kinetic resection of prostate(TPKRP),and the observation group was treated with TPKEP.The perioperative indexes(operation time,intraoperative bleeding volume,prostate resection weight,bladder flushing time,indwelling catheter time,postoperative hospitalization time)and preoperative,postoperative 3 and 12 months IPSS score,QOL score,maximum urinary flow rate(Qmax),residual urine volume(RUV)and postoperative complications were compared between the two groups.Results The observation group had better operation time,intraoperative blood loss,and prostate resection weight than the control group[(75.12±38.18)min vs(90.50±45.66)min],[(98.33±26.71)ml vs(117.32±34.70)ml],[(53.82±8.05)g vs(41.80±6.77)g],the difference was statistically significant(P<0.05);there was no statistically significant difference in bladder irrigation time,urinary indwelling time,and postoperative hospital stay between the two groups(P>0.05).At 3 and 12 months after surgery,the IPSS score and QOL score of the two groups were lower than before surgery,Qmax was higher than before surgery,and RUV was lower than before surgery,the difference was statistically significant(P<0.05).The QOL score of the observation group at 3 months after operation was higher than that of the control group,and the RUV was lower than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in the IPSS score and Qmax at 3 months after operation between the two groups(P>0.05).The Qmax of the observation group at 12 months after operation was higher than that of the control group,and the RUV was lower than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in IPSS score and QOL score between the two groups after 12 months(P>0.05).The total incidence of complications in the observation group at 3 and 12 months after surgery was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion TPKEP is effective in treating large-volume benign prostatic hyperplasia,which can effectively shorten the operation time,reduce the amount of intraoperative blood loss,harvest more proliferative glandular tissues,and achieve satisfactory urination function,which can help improve the surgical operation quality of life and low incidence of complications,it has high clinical application value.