分区法经尿道双极等离子切除应用于80岁以上前列腺增生患者的效果与安全性

目的探讨高龄前列腺增生(BPH)患者采用分区法经尿道双极等离子切除治疗的效果及围手术期的安全性处理。方法 2006年6月至2013年1月应用分区法经尿道双极等离子切除治疗80岁以上前列腺增生患者81例,患者平均年龄85.1岁,>85岁36例;合并高血压病65例,冠心病50例,陈旧性心肌梗死7例,脑血管意外后遗症12例,慢性支气管炎、肺气肿49例,糖尿病35例。并收集患者术前、术后资料和症状评分进行对照。结果本组81例患者,其中72例均安全实施手术,手术时间17⁹4 min,失血量5094 min,失血量50²50 ml。术后随访12个月,没有出现尿失禁,最大尿流率(Qmax)由术前(4.3±3.1)ml/s上升至(14.4±3.2)ml/s,残余尿量(RUV)由术前(114.4±21.2)ml降至术后(26.7±9.2)ml,国际前列腺症状评分(IPSS)由术前(27.8±4.7)分降至术后(9.1±2.3)分,生活质量评分由术前的(5.6±1.1)分降至术后的(2.9±0.6)分,术后与术前比较均有统计学差异(P均<0.05)。结论高龄不是前列腺的手术禁忌,分区法经尿道双极等离子前列腺切除是治疗高龄前列腺增生有效、安全的方法。

Sectionalized transurethral plasmakinetic resection of prostate in treatment of advanced age patients with benign prostatic hyperplasia

Objective To assess the safety and efficacy of sectionalized transurethral plasmakinetic resection of prostate （PKRP） in the treatment of benign prostatic hyperplasia （BPH） in advanced age. Methods Clinical data of 81 BPH patients at high risk with average age of 85.1 years, ranging from 80.1 to 93 years, undergoing sectionalized PKRP in our department from June 2006 to January 2013 were collected and retrospectively analyzed. During the operations, 9 （11.1%） patients’ surgery were suspended because of the high difficulty of the surgery. The safety of sectionalized PKRP was evaluated. All patients were followed up, with the times ranging from 6 to 90 months. Parameters of urination were measured before PKRP and at 6 months after operation. Results The duration of procedure was （58±21）min ranging from 17 to 94 min;The blood loss was 50 to 250 ml. There was no case requiring blood transfusion. All the 81 patients were followed up for 6 months at least, and no urinary incontinence was found after the operation. Compared with presurgical indicators, the peak flow rate （Qmax） was increased from （4.3±3.1）ml/s to （15.4±3.2）ml/s, while the international prostate symptom score （IPSS） was decreased from 27.8±4.7 to 9.1±2.3, the quality of life （QOL） from 5.6±1.1 to 2.9±0.6, and the residual urine volume （RUV） from （114.4±21.2）ml to （26.4±9.5）ml, respectively, 6 months postoperatively （all P〈0.05）. Conclusion Prostate surgery in advanced age patients is not a contraindication, strict perioperative management helps senior patients tolerate surgery smoothly.＆amp;nbsp;Sectionalized PKRP is a safe and effective treatment for BPH patients, especially for the advanced age patients.