经尿道等离子前列腺剜除术治疗大体积前列腺增生126例疗效观察

Observation on the effect of transurethral plasmakinetic enucleation of prostate for 126 patients with large-volume prostatic hyperplasia

目的探讨经尿道等离子前列腺剜除术(TUKEP)治疗大体积前列腺增生的安全性和疗效。方法回顾性分析运城市中心医院2015年10月至2017年4月收治的大体积前列腺增生(前列腺质量>80 g)患者126例的临床资料,根据前列腺质量大小采用不同的剜除方式:前列腺质量为80~120 g时采用球形剜除术;前列腺质量>120 g采用分叶剜除术,分析手术相关指标、临床效果。结果126例均顺利完成手术,手术中剜除时间(19.4±2.4)min,收获式切割时间(61.9±16.7)min,术中出血量(65.3±47.5)mL,术中切除前列腺质量(104.5±23.1)g;患者术中发生包膜穿孔5例,术后留置尿管1周,拔除尿管后排尿通畅,未出现再出血及尿道感染;术中输血7例;术中及术后均未出现电切综合征;术后随访1~6个月,失访23例,术后出现暂时性尿失禁14例,对患者进行健康教育并行提肛训练,随访中均完全控尿。患者术后国际前列腺症状评分、生活质量评分、最大尿流率、残余尿量分别为(7.6±1.4)分、(1.7±0.6)分、(20.2±3.1)mL/s、(15.0±9.3)mL,与术前差异均有统计学意义(t=15.712、18.331、-21.382、16.380,均P<0.001)。结论TUKEP用于大体积前列腺增生安全有效,切除前列腺组织彻底,是一种有效的手术方法。

Objective To discuss the safety and curative effect of transurethral plasmakinetic enucleation of prostate(TUKEP)in the treatment of large-volume prostate hyperplasia.Methods From October 2015 to April 2017,the clinical data of 126 patients with large-volume prostate hyperplasia(weight of prostate>80 g)who admitted to Yuncheng Central Hospital were retrospectively analyzed.Different enucleation methods were used according to weight of prostate:ball enucleation for 80~120 g prostate;divided enucleation for more than 120 g prostate.The clinical data were analyzed and summarized.Results All 126 patients completed operation successfully.The mean enucleation time,cutting time upon harvesting,intraoperative blood loss and intraoperative mean weight of prostate removed of the 126 patients were(19.4±2.4)min,(61.9±16.7)min,(65.3±47.5)mL and(104.5±23.1)g,respectively.Five cases of them had capsule perforation during operation and indwelling catheter for one week after operation,and unobstructed micturition was recovered after removing the urinary catheter,with no repeated hemorrhage or urinary tract infection.Seven cases received intra-operative blood transfusion,with no transurethral resection syndrome(TURS)during and after operation.These patients were followed up for 1~6 months,23 cases lost to follow up and 14 cases suffered from temporary urinary incontinence.They received health education and levator ani training and were able to completely control urination during follow-up.The IPSS score,QOL score,Qmax and PVR of the patients after operation were(7.6±1.4)points,(1.7±0.6)points,(20.2±3.1)mL/s and(15.0±9.3)mL,respectively,which showed statistically significant differences compared with before operation(t=15.712,18.331,-21.382 and 16.380,all P<0.001).All of these indicators were obviously improved than before operation,but there was no statistically significant difference in normal ejaculation before and after operation(P=0.252).Conclusion TUKEP can radically remove prostate tissue and is an effective and safe surgical method in the treatment of large-volume prostate hyperplasia.