整合耻骨上膀胱穿刺固定腺体法的经尿道前列腺等离子剜除术疗效分析

Feasibility and safety of transurethral plasmakinetic enucleation of prostate with suprapubic bladder puncture and gland fixation

目的探讨整合耻骨上膀胱穿刺固定腺体法的经尿道前列腺等离子剜除术的可行性和安全性。方法回顾性分析2020年1—6月广西医科大学第一附属医院收治的15例良性前列腺增生患者的临床资料。年龄(70.27±5.35)岁;术前血清前列腺特异性抗原(PSA)(3.03±1.37)ng/ml,前列腺总重量80.3(70.49,96.78)g;术前残余尿量80(55,108)ml,最大尿流率(Q_(max))(6.13±2.25)ml/s;国际前列腺症状评分(IPSS)25(22,27)分,生活质量评分(QOL)5(5,6)分,国际勃起功能指数-5(IIEF-5)评分(15.38±5.10)分。15例均采用三叶法技术行经尿道前列腺等离子剜除术,将剜除后的腺体整块完全推入膀胱,后用腹腔镜气腹针行耻骨上膀胱穿刺,并经外鞘插入输尿管抓钳,钳夹固定膀胱内剜除后的腺体,在膀胱内快速电切。记录手术相关指标及并发症情况。比较术前、术后主观评分及客观指标的改善情况。结果15例手术均顺利完成,无输血、包膜穿孔、电切综合征、膀胱损伤、膀胱穿刺点撕裂出血等并发症发生。切除前列腺组织重量44(40,60)g,出血量(79.20±18.93)ml,剜除手术时间(54.13±10.88)min,电切时间(14.67±2.50)min,剜除效率(0.89±0.08)g/min,电切效率(3.26±0.36)g/min,膀胱冲洗时间(2.47±0.52)d,留置导尿管时间(3.73±0.80)d,术后住院时间(4.40±0.91)d。术后发生暂时性尿失禁1例。所有患者术后6个月均获得随访,IPSS 3(2,3)分,QOL 0(0,1)分,IIEF-5评分(20.12±2.30)分,Q_(max)(21.80±2.14)ml/s,残余尿量10(5,15)ml,与术前比较差异均有统计学意义(P<0.05),患者症状明显改善。结论整合耻骨上膀胱穿刺固定腺体法的经尿道前列腺等离子剜除术治疗良性前列腺增生疗效确切,患者主观症状和客观指标均得到明显改善,无手术相关并发症发生,安全可靠,是未配备经尿道组织刨削器的单位行前列腺剜除的一种可选术式。

Objective To investigate the feasibility and safety of suprapubic bladder puncture and gland fixation in transurethral enucleation of the prostate.Methods The clinical data of 15 patients with benign prostatic hyperplasia admitted to the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2020 were retrospectively analyzed.The age was(70.27±5.35)years old,preoperative serum prostate-specific antigen(PSA)level was(3.03±1.37)ng/ml,preoperative total prostate weight was 80.3(70.49,96.78)g,preoperative postvoid residual urine volume(PVR)was 80(55,108)ml,and the maximum urine flow rate(Q_(max))was(6.13±2.25)ml/s.The international prostate symptom score(IPSS)was 25(22,27),quality of life(QOL)score was 5(5,6),international erectile function index-5(IIEF-5)score was(15.38±5.10).All 15 patients underwent conventional transurethral plasma enucleation of prostate by using the three-lobe method,and the enucleated gland was pushed into the bladder completely.Then a laparoscopic pneumoperitoneum needle was used to perform suprappubic cystipuncture,and ureteral grasping forceps were inserted through the outer sheath.The forceps were used to fix the enencied gland.A rapid harvesting electric resection was performed in the broad space of the bladder,and the Ellick was rinsed to remove the tissue fragments.Surgical indicators and complications were recorded.The improvement of subjective score(IPSS,QOL,IIEF-5)and objective index(Q_(max),PVR)was compared between preoperative and postoperative.Results All the 15 operations were completed successfully and there were no complications such as blood transfusion,capsule perforation,transurethral resection syndrome,bladder injury,bladder puncture site laceration and bleeding.The weight of resected prostate tissue was 44(40,60)g,with blood loss(79.20±18.93)ml.The time of enucleation operation was(54.13±10.88)min,with harvest cutting time(14.67±2.50)min,evisceration efficiency(0.89±0.08)g/min,harvesting efficiency(3.26±0.36)g/min,bladder irrigation time(2.47±0.52)d.The time of indwelling catheter was(3.73±0.80)d.The postoperative hospital stay was(4.40±0.91)d.Temporary urinary incontinence occurred in 1 case after operation.All patients were followed up for 6 months after operation.The IPSS score was 3(2,3),QOL score was 0(0,1),IIEF-5 score was(20.12±2.30),Q_(max)was(21.80±2.14)ml/s and PVR was 10(5,15)ml,which were all significantly different compared with those before surgery(P<0.05).The symptoms of the patients were significantly improved.Conclusions Transurethral plasma enucleation of prostate combined with suprapubic bladder puncture and fixed gland is effective in the treatment of benign prostatic hyperplasia.The subjective symptoms and objective examination of patients have been significantly improved,and no adverse operation-related complications have occurred.It is a suitable method for enucleation of prostate in units which are not equipped with transurethral tissue planer.