自调12°铲状电极保留部分尿道前列腺部前壁等离子经尿道前列腺剜切术(35例)临床探索

A clinical study of TUERP in 35 cases with self-regulated 12°spatular-electrode and transurethral preservation of part of prostatic urethra

目的探讨自调12°铲状电极保留部分尿道前列腺部前壁等离子经尿道前列腺剜切术的临床疗效。方法选取2015年9月至2020年1月昆山市第一人民医院诊治的35例保留部分尿道前列腺部前壁行等离子经尿道前列腺剜切术患者的临床资料进行回顾性分析。术中规划保留尿道前壁:在膀胱颈11点位和1点位,应用90°电切环切除尿道前列腺部尿道黏膜和部分腺体,绘出两条斜行标记线,远端分别抵达前列腺尖部10点位和2点位,标识纵沟。调节90°电切环弯度为12°,进行剜除同步止血。剜除结束后,将电切环调整回90°,切除剜下的腺体,术后留置三腔导尿管。结果35例患者手术均获得成功。手术时间(81.6±34.6)min;血红蛋白下降(11.7±6.5)g/L,12例患者术后血红蛋白未下降;留置尿管时间(4.1±1.2)d;术后住院时间(4.2±1.1)d;术后病理学检查结果均为良性前列腺增生。术后1个月国际前列腺症状评分(IPSS)为(9.9±3.7)分、生命质量(QOL)评分为(1.9±1.3)分、残余尿量(PVR)(8.5±2.9)mL、最大尿流率(Qmax)(20.5±4.6)mL/s,均较术前明显改善,手术前后比较,差异具有统计学意义(P<0.01)。拔管当日漏尿为8例,拔管后3天漏尿均消失。结论自调12°铲状电极保留部分尿道前列腺部前壁等离子经尿道前列腺剜切术是一种安全、有效的前列腺增生手术治疗方法,可减少术后漏尿发生,更适合基层医院开展。

Objective To investigate the clinical effect of transurethral preservation of part of prostatic urethral anterior wall plasma prostatic enucleation with self-regulated 12°spatula-electrode.Methods Retrospective analysis was conducted on the clinical data of 35 transurethral prostatectomy patients treated in Kunshan First People's Hospital from September 2015 to January 2020 with preservation of the anterior wall of prostate.The anterior urethral wall was reserved intraoperatively:the urethral mucosa and some glands of the prostatic urethra were resected by 90°electric ring at 11 and 1 points of the bladder neck,and two oblique marking lines were drawn,reaching 10 and 2 points of the prostatic apex respectively at the distal end to mark the longitudinal groove.Adjust the bending degree of 90°electric cutting ring to 12°,and carry out enucleation and hemostasis synchronously.After the enucleation,the electrosurgical ring was adjusted back to 90°to remove the enucleated glands,and a three-chamber catheter was indwelled postoperatively.Results The operation was successful in all 35 patients.The operation time was(81.6±34.6)min.Hemoglobin decreased(11.7±6.5)g/L,and 12 patients had no decreased hemoglobin after surgery.Catheter indwelling time(4.1±1.2)d;Postoperative hospital stay(4.2±1.1)d;Postoperative pathological examination results were all benign prostatic hyperplasia.One month after the operation,IPSS was(9.9±3.7)points,QOL was(1.9±1.3)points,residual urine volume was(8.5±2.9)mL,and maximum urine flow rate(Qmax)was(20.5±4.6)mL/s,all of which were significantly improved compared with those before and after the operation,and the differences were statistically significant(P<0.01).The leakage of urine on the day of extubation was 8 cases,and all disappeared within 3 days after extubation.Conclusions Self-regulating 12°spatulated-electrode transurethral plasma prostatectomy with partial anterior wall of prostate preserved is a safe and effective surgical treatment for prostatic hyperplasia,which can reduce the incidence of postoperative urine leakage and is more suitable for basic hospitals.