经尿道等离子杆状电极解剖性前列腺剜除术的手术经验与临床疗效

Clinical experiences and efficacy of plasmakinetic anatomical enucleation of the prostate with cylindrical electrode

目的总结经尿道等离子杆状电极解剖性前列腺剜除术的关键步骤、技术要点与临床疗效。方法回顾性分析上海长征医院2018年6月至2019年12月接受经尿道等离子杆状电极解剖性前列腺剜除术患者的临床资料与手术步骤。对患者年龄、前列腺体积、手术时间、术后膀胱冲洗时间、术后住院天数、术后留置尿管时间、术后尿失禁情况进行统计学分析,比较术前与术后3个月时的国际前列腺症状评分(IPSS)勃起功能国际问卷-5(IIEF-5)最大尿流率(Qmax)残余尿量(RUV)生活质量评分(QOL)等方面情况。结果本组共有90例患者,平均年龄(69±9)岁,平均前列腺体积(67±16)ml,所有患者均顺利完成手术,无中转开放或术中更换术式,围手术期无输血、无电切综合征、无直肠和膀胱穿孔病例,无输尿管损伤等严重并发症。手术时间(65±12)min,术后膀胱冲洗(20.0±6.5)h,术后住院(3.3±0.8)d,留置尿管(6.6±1.4)d。术后随访时间10~28个月,平均(18±5)个月,术后早期尿失禁6例,均在拔除尿管2周内恢复,术后3个月时IPSS评分[(8.0±2.5)vs(24.2±5.6)],Qmax[(18.5±3.8)vs(8.0±4.8)]ml/s,RUV[(18.9±4.1)vs(109.3±14.8)]ml,QOL[(4.3±0.7)vs(1.8±0.6)],均显著优于术前(P<0.05)。41例规律性生活患者,IEF-5术前(13.4±3.9)与术后3个月时(12.6±3.5),差异无统计学意义(P=0.105),随访期间无复发及再次前列腺手术病例。结论杆状电极具备良好的组织切割及止血效果,而且操作直接,可控性好,符合手指剥离操作习惯,经尿道等离子杆状电极解剖性前列腺剜除术安全可行,可显著改善患者的排尿症状与生活质量,对患者性功能影响较小,并发症与复发率低。

Objective To explore the procedures and efficacy of plasmakinetic anatomical enucleation of the prostate with cylindrical electrode.MethodsRetrospective analysis was performed on the clinical data and operating procedure of patients who received plasmakinetic anatomical enucleation of the prostate with cylindrical electrode in Shanghai ChangZheng Hospital from June 2018 to December 2019.Statistical analysis was performed about age,prostate volume,operation time,time of bladder irrigation,postoperative hospitalization,catheter retention time and occurrence of urinary incontinence.International prostate symptom score(IPSS),international index of erectile function 5(IIEF-5),peak urinary flow rate(Qmax),postvoid residual urine volume(RUV),and quality of life score(QOL)were compared between preoperation and 3 months after surgery.Results There were a total of 90 patients in this group,the average age was(69±9)years,the volume was(67±16)ml.All the patients successfully completed the operation without transfering to open surgery or other surgical procedure.No patient received blood transfusion during perioperation period.No transurethral resection syndrome,rectal and bladder perforation,ureteral injury and other serious complications occurred.The operation time was(65±12)min,the time of bladder irrigation was(20.0±6.5)h,the postoperative hospitalization was(3.3±0.8)d,the catheter retention time was(6.6±1.3)d.Postoperative follow-up time was 10-28 months,with an average of(18±5)months,there were urinary incontinence in 6 cases and recovered within 2 weeks.IPSS[(8.0±2.5)vs(24.2±5.6)],Qmax[(18.5±3.8)vs(8.0±4.8)]ml/s,RUV[(18.9±4.1)vs(109.3±14.8)]ml,QOL[(4.3±0.7)vs(1.8±0.6)]in 3 months after surgery were significantly improved compared with preoperation(P<0.05).There was no statistically significant difference in the IIEF-5(13.4±3.9 vs 12.6±3.5)of the 41 patients with regular sex life(P=0.015).There were no recurrence or reoperation cases during the follow-up period.ConclusionsThe cylindrical electrode has good effect in tissue cutting and hemostasis,and the operation is direct and controllable,in line with the finger dissection operation habits.Plasmakinetic enucleation of the prostate with cylindrical electrode is safe and feasible,which can significantly improve the condition of urination and quality of life,but not significantly affect sexual function.The complication rate and recurrence rate were low.