“四步法”保留膀胱颈等离子前列腺剜除术治疗良性前列腺增生的疗效研究

Efficacy of four-step method transurethral plasmakinetic enucleation of prostate with preservation of the bladder neck in the treatment of benign prostatic hyperplasia

目的:探讨"四步法"保留膀胱颈等离子前列腺剜除术(FSMPKEP)治疗前列腺增生症(BPH)的安全性和有效性。方法:200例BPH患者根据手术方法分为2组,行FSMPKEP术80例与经尿道双极等离子前列腺切除术(PKRP)120例,记录患者围手术期和术后6个月有关指标并进行统计学分析。结果:术前两组一般情况比较差异无统计学意义(P>0.05)。手术时间、术后平均冲洗时间、留置尿管时间和住院时间,FSMPKEP组少于PKRP组,前者切除腺体率多于PKRP组(P<0.05)。术后6个月两组在国际前列腺症状评分(IPSS)、生活质量(QOL)评分、剩余尿(PVR)、尿失禁以及尿道狭窄等并发症方面差异无统计学意义(P>0.05)。FSMPKEP组最大尿流率(Qmax)优于PKRP组(P<0.05),分别为(19.50±2.32)ml/s和(18.60±2.58)ml/s;FSMPKEP组逆行射精的发生率低于PKRP组(P<0.05),分别为22.50%(18/80)和68.33%(82/120)。结论:FSMPKEP在治疗BPH方面与PKRP相比有相同的有效性和安全性,同时前者具有术后恢复时间短、切除组织多和逆行射精发生率低等优势,是安全、有效和较为理想的BPH治疗方法。

Objective:To explore the safety and efficiency of four-step method transurethral plasmakinetic enu-cleation of prostate with preservation of the bladder neck (FSMPKEP)for benign prostatic hyperplasia (BPH ). Methods:200 patients with BPH were divided into FSMPKEP group (n =80)and transurethral plasmakinetie resec-tion of prostate (PKRP)group (n =120).The clinical indicators of perioperative and 3-month postoperative period were analyzed.Results:There was no significant difference in preoperative factors between the two groups (P >0.05).The mean operative time,bladder irrigating time,catheterization time and hospital stay were shortened in the FSMPKEP group as compared with those in the PKRP group (P <0.05).The mean resected tissues weighted more in the FSMPKEP group than in the PKRP group (P <0.05).During the follow up period of 6 months,there was no significant difference in international prostate symptom scores (IPSS),quality of life (QOL),postvoid residual (PVR),urinary incontinence and urethral stricture between the two groups (P > 0.05 ).Maximum urinary flow (Qmax )in FSMPKEP group (1 9.50 ± 2.32 mL/s)was increased as compared with PKRP group (18.60 ± 2.58 mL/s)(P <0.05).The incidence rate of retrograde ejaculation in FSMPKEP group (22.50%,18/80)was signifi-cantly lower than in PKRP group (68.33%,82/120)(P <0.05).Conclusions:FSMPKEP is as effective as PKRP for the treatment of BPH,which has the characteristic of short postoperative recovery time,more removal of the&nbsp;prostate tissue and low incidence rate of retrograde ejaculation at the same time.FSMPKEP is safe,effective and ide-al minimally invasive treatment procedure for BPH.