不同手术方案治疗高危良性前列腺增生症患者的疗效对比研究

A comparative study on the efficacy of different surgical procedures in the treatment of high-risk benign prostatic hyperplasia

目的比较经尿道前列腺电切除术(TURP)、经尿道前列腺剜除术(TUEP)、经尿道选择性绿激光前列腺汽化术(PVP)、经尿道前列腺等离子剜除术(TUPKEP)、经尿道前列腺等离子切除术(TUPKRP)5种手术方法治疗高危患者良性前列腺增生症(BPH)疗效。方法选取2016年4月至2017年5月杭州市富阳区第一人民医院诊治的263例高危BPH患者作为研究对象。根据手术方法,将患者分为五组,其中TURP组56例,TUEP组52例,PVP组54例,TUPKEP组51例,TUPKRP组50例。记录患者术中、术后指标手术时间(T1)、术中出血量(AB)、术后膀胱冲洗时间(T2)、术后留置导尿管时间(T3)、前列腺体体积(PV)和术后住院时间(T4)并发症情况;记录患者术前、术后3个月的最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺状态评分(IPSS)和生活质量评分(QOL)。结果 PVP组T1、AB、T3、T4较TURP组、TUPKRP组、TUEP组、TUPKEP组均显著降低,差异具有统计学意义(P<0.05);TUPKEP组T1、AB、T2、T3、T4较TURP组、TUPKRP组、TUEP组均显著降低,差异具有统计学意义(P<0.05);TUEP组AB、T2、T3、T4较TURP组均显著降低,差异具有统计学意义(P<0.05),较TUPKRP组显著升高,差异具有统计学意义(P<0.05);TUPKRP组AB、T2、T3、T4较TURP组均显著降低,差异具有统计学意义(P<0.05)。术前五组IPSS、Qmax、PV、PVR、QOL比较无差异(P>0.05),术后3个月五组组间IPSS、Qmax、PV、PVR、QOL比较差异无统计学意义(P>0.05),IPSS、Qmax、PV、PVR、QOL均较手术前有显著改善,差异具有统计学意义(P<0.05);五组组间术后各并发症发生率比较差异无统计学意义(P>0.05);各组随访期间无复发。结论 TURP、TUPKRP、TUEP、TUPKEP、PVP治疗高危BPH有效性及并发症发生率无显著差异,TUPKRP、TUEP、TUPKEP、PVP安全性均高于TURP,以PVP最优。

Objective To compare the efficacy of transurethral prostatic resection(TURP),transurethral enucleation of the prostate(TUEP),transurethral green laser photoselective vaporization of prostate(PVP),transurethral plasmakinetic enucleation of the prostate(TUPKEP),transurethral plasmakinetic resection of the prostater(TUPKRP)in the treatment of patients with high-risk benign prostatic hyperplasia(BPH).Methods 263 patients with high-risk BPH admitted to our hospital from April 2016 to May 2017 were divided into five groups according to the operation method,including 56 patients in TURP group,52 patients in TUEP group,54 patients in PVP group,51 patients in TUPKEP group,and 50 patients in TUPKRP group.The operative time(T1),intraoperative bleeding volume(AB),postoperative bladder irrigation time(T2),postoperative indwelling catheter time(T3),prostatic volume(PV),and postoperative hospitalization time(T4)and complications were recorded.The maximum urinary flow rate(Qmax),residual urine volume(PVR),International Prostate status score(IPSS),and quality of life score(QOL)were recorded before and at 3 months after operation.Results T1,AB,T3,and T4 in PVP group were significantly lower than those in TURP group,TUPKRP group,TUEP group,and TUPKEP group,with statistically significant differences(P<0.05);T1,AB,T2,T3,and T4 in TUPKEP group were significantly lower than those in TURP group,TUPKRP group,and TUEP group(P<0.05);AB,T2,T3,and T4 in TUEP group were significantly lower than those in TURP group,and higher than those in TUPKRP group(all P<0.05);AB,T2,T3,and T4 in TUPKRP group were significantly lower than those in TURP group(P<0.05).There was no statistically significant difference in IPSS,Qmax,PV,PVR,and QOL among the five groups before operation(P>0.05),and there was no difference in IPSS,Qmax,PV,PVR,and QOL among the 5 groups at 3 months after operation(P>0.05),IPSS,Qmax,PV,PVR,and QOL were significantly improved compared with those before operation(P<0.05);there was no significant difference in the incidence of postoperative complications among the five groups(P>0.05);no recurrence occurred during follow-up.Conclusions There is no significant difference in the efficicency and incidence of complication among TURP,TUPKRP,TUEP,TUPKEP,and PVP in the treatment of high-risk BPH,and the safety of TUPKRP,TUEP,TUPKEP,and PVP is higher than that of TURP,the bestbeing PVP.