前列腺组织切除量及切除率与前列腺等离子双极电切术短期临床疗效的相关性

Relationship among resected prostatic tissue weight,resection rate and short-term clinical outcomes in men who underwent transurethral plasmakinetic prostatectomy

目的探讨前列腺组织切除量及切除率与经尿道前列腺等离子双极电切术(TUPKP)短期临床疗效的关系。方法采用前瞻性、多中心的研究方法,共274例良性前列腺增生(BPH)行TUPKP的患者纳入本研究。比较前列腺组织切除量及切除率与手术时间、血红蛋白(Hb)下降值、膀胱冲洗时间、留置尿管时间、住院时间及术后最大尿流率(Q max)、残余尿量(PVR)、国际前列腺症状评分(IPSS)和生活质量评分(QoL)等的关系。结果前列腺组织切除量与手术时间、Hb下降值和膀胱冲洗时间呈正相关。术后3个月Q max与前列腺组织切除率呈正相关(r=0.1984,P=0.0010)。前列腺组织切除率在50%~75%的患者其术后3个月Q max明显大于切除率在<25%(P<0.01)及25%~50%(P<0.05)的患者,而切除率50%~75%与>75%的患者无显著性差异(P>0.05)。而且,术后3个月Q max>20 mL/s的患者其前列腺组织切除率明显高于术后3个月Q max≤20 mL/s的患者(60.2%±18.0%vs.43.5%±19.1%,P<0.0001)。根据术前前列腺体积大小将患者分组(≤30 mL、30~≤60 mL、60~90 mL和>90 mL),结果显示前列腺体积较大的患者术后倾向于获得更好的Q max和IPSS。结论前列腺组织切除量及切除率会影响TUPKP的短期临床疗效,前列腺体积较大的患者可能获得更好的临床效果。

Objective To explore the relationship among resected prostatic tissue weight,resection rate and clinical outcomes of transurethral plasmakinetic prostatectomy(TUPKP)for patients with benign prostatic hyperplasia(BPH).Methods A total of 274 men with symptomatic BPH who underwent TUPKP were enrolled in this multicenter prospective study.The operation time,hemoglobin(Hb)changes,bladder irrigation time,urinary catheter indwelling time,hospital stay,postoperative maximum flow rate(Q max),residual urine volume(PVR),International Prostatic Symptom Score(IPSS),and Quality of Life(QoL)were assessed.The relationship among resected prostatic tissue weight,resection rate and clinical outcomes was investigated.Results There was positive correlation among resected tissue weight and operation time,Hb changes and bladder irrigation time.Three months after operation,Q max was positively correlated with resection rate(r=0.1984,P=0.0010).Patients with resection rate between 50%-75%had higher Q max than those with resection rate below 25%(P<0.01)and between 25%-50%(P<0.05),while there was no difference in Q max between patients with resection rate between 50%-75%and those with resection rate above 75%(P>0.05).Patients with Q max>20 mL/s had higher resection rate than those with Q max≤20 mL/s(60.2%±18.0%vs.43.5%±19.1%,P<0.0001).Classification of the patients into groups depending on preoperative prostate volume(≤30 mL,30-≤60 mL,60-90 mL,>90 mL)showed patients with larger prostate volume tended to have higher Q max and IPSS.Conclusion The resected prostatic tissue weight and resection rate will affect the short-term clinical outcomes of TUPKP,and patients with larger prostate volume tend to gain better clinical outcomes.