经尿道等离子双极电切术治疗良性前列腺增生332例报告

目的探讨经尿道等离子双极电切术治疗良性前列腺增生的安全性和疗效。方法采用英国Gyrus等离子双极电切系统，于6点处开始切除前列腺中叶，然后分别切除两侧叶腺体直至前列腺包膜，切平膀胱颈部，前列腺尖部切至精阜前缘，保留F22三腔导尿管，气囊放置膀胱颈部；术后生理盐水冲洗1—2d，导尿管3～5d拔除。结果332例手术均获成功，手术时间（85．0±12．0）min；术中出血量30—650ml，中位数115．0ml，早期有10例输血200～400ml；无经尿道电切综合征和闭孔神经反射发生。术后发生前尿道炎性狭窄14例，经门诊尿道扩张后治愈；暂时性尿失禁15例，经提肛训练1～3周恢复正常。332例术后随访1～6个月，最大尿流率（Qmax）由术前（7．6±2．4）ml／s升高到术后（22．6±3．4）ml／s（t=13．582，P=0．000）；国际前列腺症状评分由术前（27．3±1．5）分降到术后（7．0±1．2）分（t=16．394，P=0．000）；生活质量评分由术前（4．3±0．4）分降到术后（2．1±0．8）分（t=9．761，P=0．005）。结论经尿道等离子双极电切是治疗BPH的一种安全有效的方法。

Transurethral Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia:Report of 332 Cases

Objective To discuss the efficacy and safety of transurethral plasmakinetic resection of the prostate （PKRP） for benign prostatic hyperplasia （BPH）. Methods A British made Bipolar plasmakinetic resection system （Gyms） was employed in this series. Started from the 6 o＇ clock point, the middle lobe of the prostate was resected, followed by the left and right lobes, which were resected down to the prostate capsule. And then the bladder neck was cut down. The apical tissues were resected to the anterior border of the seminal colliculus. After the operation, a F22 three-channel catheter was indwelled for 3 to 5 days after the operation, and a balloon was place in the bladder neck. Results The procedure was completed successfully in all of the cases with a mean operation time of （85.0±12. 0） min, and a median blood loss 115.0 ml （30 to 650）. Ten patients received blood transfusion during the operation （200 to 400 ml）. No case showed transurethral resection syndrome or obturator nerve reflex. Fourteen patients developed inflammatory stricture of the anterior ureter and was then cured by dilating the urinary tract; 15 cases showed transient urinary incontinence and was cured after pelvic floor muscle training for 1 to 3 weeks. Follow-up was available in the patients for 1 to 6 months, during which the mean Qmax of the patients significantly increased compared to that preoperation [ from （7.6 ± 2. 4） ml/s to （22. 6 ± 3.4） ml/s, t = 13. 582, P = 0. 000） , and the IPSS and life quality score markedly decreased [ from 27.3 ± 1.5 and 4. 3 ±0. 4 to 7.0 ± 1.2 and 2.1 ± 0. 8 ; t = 16. 394 and 9. 761, P = 0. 000 and 0. 005, respectively] Conclusion PKRP is an effective and safe treatment for BPH.