腔内技术治疗高龄及高危良性前列腺增生的应用(附283例报告)

目的:探讨和总结腔内治疗技术在高龄和高危良性前列腺增生(BPH)患者中应用的安全性、有效性和治疗经验。方法:采用腔内治疗技术,包括经尿道等离子体前列腺电切术(transurethral plasmakinetic resectionof prostate,PKRP)和经尿道前列腺电切术(transurethral resection of the prostate,TURP),治疗高危(包括合并肾积水、肾功能不全、心功能不全、脑梗塞、慢性呼吸功能障碍、中重度贫血、糖尿病、膀胱肿瘤等疾病或腺体>80 g)、高龄(年龄>70岁)BPH患者283例,其中TURP组112例,PKRP组171组。结果:所有患者术后随访1~30个月。TURP组的国际前列腺症状评分(IPSS)、生活质量评分(QOL)和残余尿量(RUV)由术前的(27.5±2.8)分、(5.5±1.0)分和(75.0±20.0)ml下降至术后的(5.8±1.2)分、(1.0±0.5)分和(8.0±3.0)ml,而最大尿流率(Qmax)由术前的(6.5±2.0)ml/s上升至术后的(18.5±1.5)ml/s(P均<0.05);PKRP组的IPSS、QOL和RUV由术前的(28.2±2.2)分、(5.5±1.0)分和(80.0±20.0)ml下降至术后的(5.4±1.6)分、(1.0±0.5)分和(7.0±3.0)ml,而Qmax由术前的(6.8±2.1)ml/s上升至术后的(20.0±1.5)ml/s(P均<0.05)。两组的治疗效果之间的差异无统计学意义(P>0.05),而PKRP组术后并发症发生率较TURP组少(P<0.05)。结论:年龄在70岁以上伴有心肺、脑肾等重要脏器合并症的高龄及高危BPH患者,经腔内技术治疗,特别是以PKRP治疗,在全面的围手术期准备护理、熟练的手术操作、有效控制手术时间及术后密切监护、加强护理的情况下,具有出血少、安全性高、并发症少、疗效确切等优点。

Endourological treatment of aged high-risk patients with benign prostate hyperplasia: A report of 283 cases

Objective:To evaluate the safety and effectiveness of endourological techniques in the treatment of benign prostate hyperplasia(BPH) in aged high-risk patients.Methods:We used endourological techniques in the treatment of 283 BPH patients aged over 70 years and complicated with hydronephrosis,renal failure,heart failure,cerebral infarction,respiratory dysfunction,anemia,diabetes,bladder tumor,or prostate weight over 80 g,TURP(transurethral resection of the prostate) for 112 cases and PKRP(transurethral plasmakinetic resection of the prostate) for the other 171.All the patients were followed up for 1-30 months.Results:In the TURP group,the scores on IPSS and QOL were decreased from 27.5 ± 2.8,5.5 ± 1.0 to 5.8 ± 1.2,1.0 ± 0.5,and the residual urine volume(RUV) from(75.0 ± 20.0) ml to(8.0 ± 3.0) ml,but the maximal flow rate(Qmax) increased from(6.5 ± 2.0) ml/s to(18.5 ± 1.5) ml/s(P < 0.05),while in the PKRP group,the scores on IPSS and QOL were decreased from 28.2 ± 2.2,5.5 ± 1.0 to 5.4 ± 1.6,1.0 ± 0.5,and RUV from(80.0 ± 20.0) ml to(7.0 ± 3.0) ml,and Qmax increased from(6.8 ± 2.1) ml/s to(20.0 ± 1.5) ml/s(P < 0.05).There were no statistically significant differences in IPSS,QOL,Qmax and RUV after treatment between the two groups(P > 0.05),but significantly less complications were found in the PKRP than in the TURP group(P < 0.05).Conclusion:Endourological treatment,especially PKRP,with comprehensive perioperative preparations,unerring operative skills,well-controlled operation time,and intensive postoperative monitoring and nursing,has the advantages of high safety,less bleeding,fewer complications and definite effectiveness for aged high-risk BPH patients.Natl J Androl,2010,16(9):803-806