良性前列腺增生合并膀胱癌患者经尿道膀胱肿瘤切除术后不同时机行经尿道前列腺切除术治疗的临床对比研究

A Clinical Comparative Study of Patients with Benign Prostatic Hyperpla⁃sia and Bladder Cancer Undergoing Transurethral Resection of the Pros⁃tate at Different Times after Transurethral Cystectomy

目的对比研究良性前列腺增生(BPH)合并膀胱癌患者经尿道膀胱肿瘤切除术(TURBT)术后不同时机行经尿道前列腺切除术(TURP)治疗的临床效果。方法方便选取2018年5月—2019年4月期间该院收治的61例BPH合并膀胱癌患者为研究对象,根据分层随机化分组法分为研究组31例及对照组30例,所有患者均行TURBT治疗,研究组同期行TURP治疗,对照组择期行TURP治疗。观察两组患者围术期基本情况(手术总时间、术中总出血量、住院总时间),对比术前与术后1个月两组患者尿动力学指标(最大尿流率、残余尿量、膀胱内压)变化,并分析比较术后1个月两组患者并发症发生情况。结果研究组手术总时间、术中总出血量、住院总时间(67.58±10.72)min、(124.51±26.88)mL、(16.78±3.11)d均低于对照组(92.66±22.56)min、(155.43±27.24)mL、(28.66±7.24)d,差异有统计学意义(t=5.574、4.462、8.374,P<0.05)。术前,两组最大尿流率、残余尿量及膀胱内压水平比较差异无统计学意义(P>0.05),术后1个月,两组患者最大尿流率均较术前显著升高,且研究组(18.56±4.20)mL/s明显高于同一时间对照组(15.07±2.93)mL/s,差异有统计学意义(t=3.752,P<0.05);两组患者残余尿量及膀胱内压水平均明显较术前降低,且研究组(33.84±7.65)mL、(13.32±3.03)cmH2O明显低于同一时间对照组(42.06±9.54)mL、(18.15±4.02)cmH2O,差异有统计学意义(t=3.718、5.310,P<0.05);研究组患者术后尿潴留、尿失禁及吻合口狭窄等术后并发症总发生率与对照组比较差异无统计学意义(P>0.05)。结论BPH合并膀胱癌患者TURBT术后同期进行TURP治疗,可有效缩短手术时间和住院时间,降低术中出血量,加快膀胱功能恢复,且安全性良好,具有较高临床应用价值。

Objective To compare the clinical effects of transurethral resection of the prostate(TURP)at different times after transurethral resection of the bladder tumor(TURBT)in patients with benign prostatic hyperplasia(BPH)complicated with bladder cancer.Methods A total of 61 patients with BPH complicated with bladder cancer who were treated in the hospital from May 2018 to April 2019 were conveniently selected as the research objects,and they were divided into 31 cases in the study group and 30 cases in the control group according to the stratified randomization method.All patients were treated with TURBT,the study group was treated with TURP at the same time,and the control group was treated with TURP as scheduled.The perioperative basic conditions of the two groups of patients(total operation time,total intraoperative blood loss,and total hospitalization time)were observed,the changes of urodynamic indexes(maximum urine flow rate,residual urine volume,intravesical pressure)in the two groups before operation and 1 month after operation were compared,and the incidence of complications in the two groups was analyzed and compared 1 month after operation.Results The total operation time,total intraoperative blood loss,and total hospitalization time in the study group were(67.58±10.72)min,(124.51±26.88)mL,and(16.78±3.11)d,which were lower than those in the control group(92.66±22.56)min,(155.43±27.24)mL and(28.66±7.24)d,the difference was statistically significant(t=5.574,4.462,8.374,P<0.05).Before operation,there was no statistically significant difference in the maximum urinary flow rate,residual urine volume and intravesical pressure between the two groups(P>0.05).One month after operation,the maximum urinary flow rate of the two groups was significantly higher than that before operation.and the research group(18.56±4.20)mL/s was significantly higher than the control group(15.07±2.93)mL/s at the same time,the difference was statistically significant(t=3.752,P<0.05);the residual urine volume and intravesical pressure levels of the two groups of patients were significantly lower than those before surgery,and the study group(33.84±7.65)mL,(13.32±3.03)cmH2O were significantly lower than the control group(42.06±9.54)mL,(18.15±4.02)cmH2O at the same time,the difference was statistically significant(t=3.718,5.310,P<0.05);there was no statistically significant difference in the total incidence of postoperative complications such as urinary retention,urinary incontinence and anastomotic stenosis between the study group and the control group(P>0.05).Conclusion TURP treatment in patients with BPH complicated with bladder cancer after TURBT operation can effectively shorten the operation time and hospitalization time,reduce the amount of intraoperative blood loss,and speed up the recovery of bladder function,with good safety and high clinical application value.