新型国产犁形电极经尿道前列腺等离子剜除术在日间手术治疗大体积BPH的对比研究

Comparison study of the transurethral plasmakinetic enucleation of prostate with domestic plough-shaped electrode in the treatment of large benign prostatic hyperplasia in day surgery

目的:为了探讨日间手术模式下国产新型犁形电极(大禹刀)经尿道前列腺等离子剜除术(transurethral plasmakinetic enucleation of prostate,PKEP)治疗大体积良性前列腺增生(benign prostatic hyperplasia,BPH)的临床疗效和可行性。方法:回顾性分析2020年7月—2022年8月粤北人民医院泌尿外科日间手术病房收治的110例大体积BPH患者资料,按照使用电极不同将患者分为大禹刀组和普通环状电极组;大禹刀组56例采用日间手术模式下的大禹刀PKEP治疗,环状电极组54例采用日间手术模式下普通环状电极PKEP治疗,手术均由同一主任医师完成,对2组的手术时间、术后24 h血红蛋白下降值、术后膀胱持续冲洗时间、术后留置尿管时间、住院总费用、人均电极耗材费用、术后6个月最大尿流率(Q_(max))、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、膀胱残余尿量(PVR)及术中术后并发症发生等进行比较分析。结果:环状电极组有1例因术后出血转入普通病房、退出研究,其余109例患者均顺利完成PKEP日间手术并24 h内出院。大禹刀组的手术时间[(50±5.6)min vs(65±8.4)min]、术后血红蛋白下降[(4.2±0.5)g/L vs(8.3±1.6)g/L]、术后膀胱持续冲洗时间[(5.2±2.14)h vs(8.4±1.3)h]、术后尿管留置时间[(2.3±1.8)d vs(4.5±2.2)d]均显著低于环状电极组(P<0.05);大禹刀组的人均电极耗材费用低于环状电极组;2组术中术后的并发症发生、术后6个月的Qmax、IPSS、QOL、PVR比较差异均无统计学意义(P>0.05)。结论:应用国产大禹刀行PKEP日间手术治疗大体积BPH,具有简单易学、手术时间短、出血少、耗材费用低等优势,可促进患者早日康复,适合在基层单位推广和应用。

Objective To investigate the efficacy and feasibility of transurethral plasmakinetic enucleation of the prostate(PKEP)with domestic plough-shaped plasma electrode(Da Yu Dao)in the treatment of large benign prostatic hyperplasia(BPH)in day surgery.Methods The clinical data of 110 patients with large BPH were retrospectively analyzed in day surgery department of urology,Yue Bei People's Hospital,from July 2020 to August 2022.All patients were divided into two groups according to electrode.All operations were performed by the same chief physician in urology by PKEP with Da Yu Dao and common annulus plasma electrode,respectively.The operation time,postoperative hemoglobin decrease,bladder irrigation time,indwelling catheterization time,total hospitalization cost,electrode expense per capita,maximum urinary flow rate(Q_(max))at postoperative six months,international prostate symptom score(IPSS),quality of life(QOL)score,postvoid urine volume(PVR)and postoperative complications were compared between the two groups.Results The study showed all operations were successfully completed.A patient in annulus electrode group was transferred to common ward because of the postoperative bleeding and excluded,while the other 109 patients finished hospitalization,operation and recovery from hospital in 24 hours.The operation time,postoperative blood loss,bladder irrigation time and indwelling catheterization time were(50±5.6)min vs(65±8.4)min,(4.2±0.5)g/L vs(8.3±1.6)g/L,(5.2±2.14)h vs(8.4±1.3)h and(2.3±1.8)d vs(4.5±2.2)d in Da Yu Dao group and common annulus electrode group,respectively,P<0.05.The electrode expense per capita in Da Yu Dao group was lower than that in the annulus electrode group.There was no difference in Qmax,IPSS,QOL,PVR,postoperative complications or other indicators between two groups.Conclusion It is suggested that the clinical efficacy of PKEP with Da Yu Dao for the treatment of large BPH is safe and effective in day surgery mode.It can promote the rapid recovery of patients and reduce hospitalization expenses.It is worthy of wide application in basic hospital.