经尿道前列腺柱状水囊扩开术与经尿道前列腺电切术治疗良性前列腺增生的疗效对比

Transurethral resection of the prostate versus transurethral columnar balloon dilatation of the prostate in the treatment of benign prostatic hyperplasia

目的:对比经尿道前列腺柱状水囊扩开术(TUCBDP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的疗效。方法:2021年7月至2022年11月,218例我院收治的BPH组患者随机分为两组,每组109例,一组采用TURP进行治疗(TURP组),另一组采用TUCBDP进行治疗(TUCBDP组),两组均观察至患者出院,出院后随访1年。比较两组临床疗效、手术情况、术后恢复情况、并发症发生情况、血清疼痛、炎症指标、细胞因子水平、尿流动力学指标、症状改善情况、生活质量。结果:术后1年与TURP组比较,TUCBDP组总有效率更高(P<0.05)。TUCBDP组手术情况、术后恢复情况优于TURP组(P<0.05)。TURP组和TUCBDP组术后1 d血清PGE2、P物质、TNF-α、hs-CRP水平与术前比较,升高,但TUCBDP组较TURP组更低(P<0.05)。TURP组和TUCBDP组术后3个月血清PSA、E2水平与术前比较,降低,TUCBDP组较TURP组更低;血清T水平与术前比较,升高,TUCBDP组较TURP组更高(P<0.05)。术前及术后3个月、1年,TURP组和TUCBDP组PVR及NIH-CPS、IPSS、QOL评分呈降低趋势,TUCBDP组术后3个月较TURP组更低(P<0.05);术前及术后3个月、1年,TURP组和TUCBDP组Qmax、MCC、MUCP呈升高趋势,TUCBDP组术后3个月较TURP组更高(P<0.05)。结论:与TURP相比,TUCBDP改善BPH患者手术情况,促进术后恢复,提高生活质量,降低术后疼痛、机体炎症反应及并发症的发生,调节血清细胞因子水平,改善患者尿流动力学及临床症状,疗效较好,但随着术后时间延长,两种方法对尿流动力学、症状及生活质量的改善效果基本相当。

Objective:To compare the effects of transurethral resection of the prostate(TURP)and transurethral columnar balloon dilatation of the prostate(TUCBDP)in the treatment of BPH.Methods:This study included 218 BPH patients treated in Qinhuangdao Workers'Hospital from July 2021 to November 2022,109 by TURP and the other 109 by TUCBDP.We followed up the patients for 12 months,observed their postoperative recovery,complications,serum pain,inflammatory index,cytokine level,urodynamic index,symptom improvement and quality of life(QOL)and compared the data obtained between the two groups of patients.Results:At 12 months after surgery,the total effectiveness rate was significantly higher in the TUCBDP than in the TURP group(93.58%vs 84.40%,P<0.05),and the postoperative recovery was better in the former than in the latter(P<0.05).Compared with the baseline,the levels of serum prostaglandin E2(PGE2),substance P,tumor necrosis factor-alpha(TNF-α)and high sensitive C-reactive protein(hs-CRP)were remarkably increased in both of the groups on the first day after surgery(P<0.05),more significantly in the TURP than in the TUCBDP group(P<0.05),while the levels of serum PSA and E2 decreased and the T level elevated in all the patients at 3 months postoperatively(P<0.05),more significantly in the TUCBDP than in the TURP group(P<0.05).Before and at 3 and 12 months after operation,the postvoid residual urine volume(PVR)and NIH-CPSI,IPSS and QOL scores showed a decreasing trend,while the maximum urinary flow rate(Qmax),maximum cystometric capacity(MCC)and maximum urethral closure pressure(MUCP)exhibited an increasing trend in both of the two groups,even more significantly in the TUCBDP than in the TURP group(P<0.05).Conclusion:TUCBDP is advantageous over TURP in promoting postoperative recovery,improving QOL,reducing postoperative pain,inflammation and complications,regulating the levels of serum cytokines,and improving urodynamics and clinical symptoms in BPH patients.However,with the extension of postoperative time,the two strategies are basically comparable in improving the urodynamics,symptoms and QOL of the patients.