三种不同腔内技术治疗重度前列腺增生的比较研究

Comparative study among three different intracavity techniques for the treatment of severe prostatic hyperplasia

目的:探究经尿道前列腺电切术(TURP)、经尿道前列腺等离子切除术(PKRP)、经尿道前列腺等离子剜除术(PKEP)3种不同腔内技术对重度前列腺增生患者的疗效、手术相关指标、国际前列腺症状评分(IPSS)、生存质量评分(QOL)及术后并发症的影响。方法:选择2014年6月～2017年4月在我院接受治疗的185例重度前列腺增生患者为研究对象,按随机数字表法分为TURP组(n=60)、PKRP组(n=61)、PKEP组(n=64)。TURP组采用经尿道前列腺电切术,PKRP组采用经尿道前列腺等离子切除术,PKEP组采用经尿道前列腺等离子剜除术;观察三组手术持续时间、腺体切除量、术中出血量等手术情况,比较三组术前术后最大尿流率(Q_(max))、残余尿量(RUV)、IPSS评分及QOL评分,并统计三组术后并发症发生情况。结果:术后PKEP组临床总有效率高于TURP组和PKRP组(P<0.05),而TURP组与PKRP组总有效率比较差异无统计学意义(P>0.05);与TURP组比较,PKRP组和PKEP组手术持续时间、术中出血量、RUV水平及IPSS评分、QOL评分均降低,而腺体切除量及Q_(max)水平均升高,差异有统计学意义(P<0.01);与PKRP组比较,PKEP组手术持续时间、术中出血量、RUV水平、IPSS评分及QOL评分均降低,而腺体切除量及RUV水平升高,差异有统计学意义(P<0.01);三组术后并发症发生率比较差异有统计学意义(P<0.05);三组术前Q_(max)、RUV水平、IPSS评分及QOL评分比较差异无统计学意义(P>0.05)。结论:采用3种不同腔内技术治疗重度前列腺增生患者,PKEP组患者总有效率高、手术时间短、术中出血量少、腺体切除量多且并发症少,能有效缓解患者病症,提高生活质量,临床疗效显著。

Objective:To explore the influence of transurethral resection of the prostate(TURP),transurethral plasmakinetic resection of prostate(PKRP),transurethral plasmakinetic enucleation of prostate(PKEP)three kinds of different intracavity techniques on curative effect,operation related index,International Prostate Symptom Score(IPSS score),quality of life score(QOL score)and postoperative complications of patients with severe prostatic hyperplasia.Method:From June 2014 to April 2017,185 cases with severe prostatic hyperplasia treated in our hospital were selected as the study objects,and were divided into three groups,60 cases in TURP group,61 cases in PKRP group,64 cases in PKEP group.The TURP group were given transurethral resection of the prostate,the PKRP group were given transurethral plasmakinetic resection of prostate,and the PKEP group were given transurethral plasmakinetic enucleation of prostate.Operation duration time,gland resection volume,intraoperative blood loss and other operation data were observed,maximum urinary flow rate(Qmax),residual urine volume(RUV),IPSS score and QOL score before and after operation were compared,and postoperative complications were recorded in the three groups.Result:After operation,total effective rate of PKEP group was higher than that of TURP group and PKRP group(P<0.05),but there was no significant difference between TURP group and PKRP group(P>0.05).Compared with those in TURP group,operation duration,intraoperative blood loss,RUV level,IPSS score and QOL score in PKRP group and PKEP group all decreased,and gland resection volume and Qmax levels all elevated,with statistically significant difference(P<0.01).Compared with those in PKRP group,operation duration time,intraoperative blood loss,RUV level,IPSS score and QOL score in PKEP group decreased,while the amount of gland resection and RUV level increased,with statistically significant difference(P<0.01).There was statistically significant difference in the incidence of postoperative complications among three groups(P<0.05).There was no significant difference in preoperative Qmax,RUV levels,IPSS score and QOL score among three groups(P>0.05).Conclusion:Three different intracavity techniques were used to treat severe prostate patients.The PKEP group had higher total effective rate,shorter operative time,less intraoperative blood loss,more gland removal and fewer complications.It can effectively relieve the symptoms and improve the quality of life,and has significant clinical effect.