经尿道气化加电切术治疗前列腺增生症

Combined Application of Transurethral Electrovaporization Ablation and Transurethral Resection for Treatment of Benign Prostatic Hyperplasia:A Report of 218 Cases

目的探讨良性前列腺增生症 (BPH)的有效治疗方法。方法采用经尿道前列腺气化电切 (TU VP)加经尿道前列腺电切术 (TURP)联合治疗BPH患者 2 18例。结果平均手术时间 70 (2 0～ 15 0 )min ,2例术中需输血 2 0 0ml,均为Ⅲ度增生者 ,切除前列腺组织平均重量 5 0 (30～ 15 0 ) g ,未发生电切综合征 ,术后 3～ 5d拔除导尿管 ,排尿均通畅 ,随诊 1～ 6个月 ,国际前列腺症状评分 (IPSS)由术前 (2 8.5± 2 .5 )分下降至术后 (8.5±0 .5 )分 ,最大尿流率由术前平均 (6 .2± 2 .0 )ml/s升至术后 (17.5± 1.5 )ml/s,B超复查约 30例仍有剩余尿 10～ 4 0ml,平均 17.5ml,术后继发性出血 8例 ,尿道狭窄 12例 ,暂时性尿失禁 10例。结论TUVP加TURP联合治疗BPH可综合两者的优点 ,疗效显著 ,并发症少 ,安全性高 。

Objective To explore the effective therapy for treatment of benign prostatic hyperplasia(BPH).MethodsThe combined application of transurethral electrovaporization ablation(TUVP) and transurethral resection(TURP) was performed in 218 cases with BPH.ResultsThe procedures were successful and the average duration of operation was 70(20～150)min .The volume of blood transfused for two cases of grade Ⅲ prostatic hyperplasia was 200ml.The average preoperative weights of prostatic glands were 50(30～150)g, no TURP syndrome occurred. The urethral catheters were pulled out 3～5 days after operation, with fluent urine flow. All patients were followed up for l to 6 months, their international prostatic symptom scores(IPSS) decreased from 28.5±2.5 to 8.5±0.5 and maximal flow rate(MFR)of urine increased from (6.2± 2.0 ) ml/s to(17.5±1.5) ml/s.Ultrasound B examination revealed 17.5(10～40) ml of residual urine in about 30 cases. Postoperative secondary hemorrhage happened in 8 cases, urethral narrowing in 12 cases and temporary urine incontinence in 10 cases.ConclusionCombined application of TUVP plus TURP possesses the advantages of both therapies, it is efficient with high safety and low complication. It is believed to be the ideal choice for treating BPH.