经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生

目的:探讨经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生(BPH)的临床应用。方法:选择单纯BPH有手术指征患者90例,年龄59~83岁,平均71岁,随机分为2组,I组(50例)行经尿道前列腺电切术(TURP),Ⅱ组(40例)行经尿道等离子双极电刀前列腺剜除术(PKEP)。统计每例患者术前前列腺体积、国际前列腺症状(IPSS)评分、生活质量指数(QOL)评分和最大尿流率(Qm ax),手术时间,术中术后有无并发症、输血,术后有无膀胱持续冲洗及术后2周、术后6个月IPSS、QOL评分和Qm ax。结果:I组、II组术前前列腺体积平均为58.9、58.3 g;I组、II组手术时间平均为58.8、93.0 m in;I组患者中2例出现轻度电切综合征(TURS),II组患者术中术后心电监护未发现异常;术后行膀胱持续冲洗分别有3例、1例;术后导尿管拔除后出现急迫性尿失禁分别有4例;90例患者术中、术后均无输血。术前、术后2周、术后6个月IPSS评分I组平均分别为19.7分、11.6分、5.1分,II组平均分别为18.6分、8.4分、4.9分;QOL评分I组平均分别为4.6分、3.3分、1.1分,II组平均分别为4.5分、2.7分、1.1分;Qm ax I组平均分别为6.3、13.0、18.1 m l/s,II组平均分别为6.9、14.2、19.0 m l/s。两组间的手术时间、术后2周IPSS、QOL评分,各组内术前与术后6个月IPSS、QOL评分、Qm ax的差异有统计学意义(P<0.01)。两组间术前前列腺体积、术前IPSS、QOL评分和Qm ax、术后6个月IPSS、QOL评分及术后2周、术后6个月Qm ax的差异无统计学意义(P>0.05)。结论:PKEP可安全、有效、彻底治疗BPH,可作为手术治疗BPH的一种选择。

Transurethral plasmakinetic enucleation of the prostate for benign prostatic hyperplasia

Objective： To evaluate clinical application of transurethral plasmakinetic enucleation of the prostate（PKEP） to the treatment of benign prostatic hyperplasia（BPH）.Methods： A total of 90 BPH patients,aged 59-83（mean 71） years and with indication of surgery,underwent transurethral resection of the prostate（the TURP group,n = 50） and transurethral plasmakinetic enucleation of the prostate（the PKEP group,n = 40）,respectively.We recorded and analyzed the preoperative prostate volume,IPSS,QOL and Qmax,operation time,intra-and post-operative bleeding and complications,postoperative continuous bladder irrigation,and IPSS,QOL and Qmax at 2 weeks and 6 months after surgery.Results： The preoperative prostate volume and operation time were 58.9 g and 58.8 min in the TURP group versus 58.3 g and 93.0 min in the PKEP group.Mild transurethral resection syndrome（TURS） appeared in 2 TURP receivers,while no abnormality was found in electrocardiogram monitoring in those undergoing PKEP.Continuous bladder irrigation was necessitated in 3 and urgent incontinence of urine occurred in 4 cases of TURP,as compared with 1 and 4 cases in the PKEP group.None of the 90 patients needed blood transfusion.At 2 weeks before and after surgery and 6 months postoperatively,IPSS averaged 19.7,11.6 and 5.1,QOL 4.6,3.3 and 1.1,and Qmax 6.3,13.0 and 18.1 ml/s in the TURP group versus 18.6,8.4 and 4.9（IPSS）,4.5,2.7 and 1.1（QOL） and 6.9,14.2 and 19.0 ml/s（Qmax） in the PKEP group.There were significant differences in operation time,IPSS and QOL at 2 weeks postoperatively between the two groups,as well as in IPSS,QOL and Qmax at 6 months before and after surgery（P0.01）.But no remarkable differences were found in preoperative prostate volume,IPSS,QOL and Qmax,6-month postoperative IPSS and QOL,and Qmax at 2 weeks and 6 months after surgery between the two groups（P0.01）.Conclusion： Transurethral PKEP is a safe,effective and thorough surgical method to be chosen for the treatment of BPH.