改良尿道括约肌的保护技术在双极等离子前列腺剜除术中的应用

Retrospective analysis of the application of modified urethral sphincter protective technique in bipolar plasmakinetic enucleation of the prostate

目的:探讨等离子前列腺电切术(PKRP)和改良尿道括约肌保护的双极等离子前列腺剜除术(PKEP)治疗良性前列腺增生(BPH)的疗效及对尿控功能的保护作用。方法:选取2020年6月—2021年3月我院泌尿外科诊断为BPH并行手术治疗的100例患者为研究对象并回顾性分析其临床数据。改良剜除组50例患者实施改良尿道括约肌保护的PKEP(颈部环切+顶部保留),等离子电切组50例患者实施PKRP。结果:两组患者术前一般资料比较,差异均无统计学意义(P>0.05)。围术期相关资料行单因素分析发现改良剜除组手术时间长于等离子电切组[(120.4±34.9)min vs.(94.1±40.8)min,P<0.01],而术中出血量少于等离子电切组[(86.2±44.6)mL vs.(166.1±152.1)mL,P<0.01],差异有统计学意义。改良剜除组的术后QOL、术后Q_(max)及术后残余尿改善程度均优于等离子电切组,且差异有统计学意义(P<0.01)。两组间术中并发症(P=0.22)、持续膀胱冲洗时间(P=0.15)、住院时间(P=0.39)、术后IPSS(P=1.00)、术后尿失禁发生率(P=0.24)的差异无统计学意义。结论:PKEP与PKRP相比具有更好的出血控制能力,更好的术后Q_(max)及残余尿改善程度,术后不增加尿失禁等并发症发生率,对于术后尿控功能具有一定的优势。

Objective:To investigate the efficacy of plasmakinetic resection of prostate(PKRP)and modified urethral sphincter protective PKEP in the treatment of benign prostatic hyperplasia(BPH)and to compare the preservation of urine control function.Methods:A total of 100 patients with diagnosis of BPH and required surgery from June 2020 to March 2021 were selected and their clinical data were analyzed retrospectively.Fifty patients were treated with modified urethral sphincter protection of PKEP,while other 50 patients were treated with traditional PKRP.Results:There was no significant difference in preoperative general data between the two groups(P>0.05).Univariate analysis of perioperative data showed that the operation time in the PKEP group was longer than that in the traditional plasma resection group[(120.4±34.9)min,(94.1±40.8)min,P<0.01],but the intraoperative blood loss in the modified evisceration group was significantly lower than that in the traditional plasma resection group[(86.2±44.6)mL,(166.1±152.1)mL,P<0.01].The improvement of QOL in modified evisceration group was better than that in traditional plasma resection group(P<0.01).The postoperative Q_(max)and residual urine were better in the modified evisceration group than in the traditional plasma resection group,and the difference was statistically significant(all P<0.01).There was no significant difference in intraoperative complications(P=0.22),continuous bladder irrigation time(P=0.15),hospital stay(P=0.39),postoperative IPSS(P=1.00)or the incidence of postoperative urinary incontinence(P=0.24)between the two groups.Conclusion:Compared with the traditional plasma prostatectomy,the modified enucleation group has the advantages of better bleeding control,better improvement of postoperative maximum urinary flow rate and residual urine,rapid recovery and no increase in the incidence of urinary incontinence.It has certain advantages for postoperative urinary control function.