剥离式经尿道前列腺切除术与经尿道前列腺电切术治疗良性前列腺增生的比较研究

目的:比较经尿道前列腺电切术(TURP)与使用专用前列腺增生腺体剥离器行剥离式经尿道前列腺切除术(剥离式TURP,TUERP)治疗良性前列腺增生(BPH)的疗效与安全性。方法:BPH患者630例,均具备手术指征,随机分为TURP组(305例)和剥离式TURP组(325例)。术前两组年龄、前列腺体积、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)数值比较,差异无统计学意义(P均0.05)。记录两组手术时间、手术切除率、术后需要持续膀胱冲洗时间、术后生活质量评分(QOL)、手术并发症数据,进行统计学分析。结果:手术后的资料分析显示,TUERP手术切除率优于TURP组的手术切除率(60.1±12.3)%vs(47.0±13.3)%,P0.05)];TUERP组平均手术时间比TURP组短(40.4±14.2)min vs(57.9±15.9)min,P0.05];术后冲洗时间较短(2.2±1.1)d vs(2.7±0.6)d,P0.05]。TUERP组手术前后血清Na+和血红蛋白浓度变化无统计学意义,TURP组血清Na+和血红蛋白浓度变化有统计学意义血Na+:(141.2±3.5)mmol/L vs(136.9±4.7)mmol/L,P0.01,血红蛋白:(137.6±8.8)g/L vs(124.8±9.6)g/L,P0.01]。术后3个月,两组的IPSS评分、QOL评分、Qmax评分均较术前有显著改善(P均0.01),组间比较无显著性差异。(P0.05)。结论:剥离式TURP治疗BPH和TURP比较,具有手术时间短、手术切除率高、术中出血少、术后恢复快、并发症少等优点,在临床上有良好的应用前景。

Transurethral enucleative resection of the prostate versus transurethral resection of the prostate for benign prostate hyperplasia

Objective： To compare the effectiveness and safety of transurethral resection of the prostate （TURP） and transure- thral enucleative resection of the prostate （TUERP） in the treatment of benign prostate hyperplasia （BPH）. Methods ： A total of 630 BPH patients with indication of surgery were randomly assigned to receive TURP （ n =305 ） and TUERP （ n = 325 ）, respectively. There were no significant differences preoperatively in age, prostate volume, International Prostate Symptom Score （IPSS）, and Qmax between the two groups （ P 〉 0.05 ）. The prostate resection rate, operation time, postoperative complications, and quality of life （QOL） of the patients were recorded and statistically analyzed. Results ： Compared with TURP, TUERP showed a significantly high- er rate of prostate resection （ 47.0± 13.3 ] vs 60.1±12.3 ] %, P 〈 0.05 ）, shorter operation time （ 57.9 ± 15.9 ] vs 40.4±14.2] min, P 〈0.05）, and shorter bladder irrigation time （ 2.7±0.6] vs 2.2 ± 1.1 ] d, P 〈0.05）. Significant differences were found between the pre- and post-operative levels of serum sodium and hemoglobin in the TURP group （ 141.2 ± 3.5 ] vs 136.9 ± 4.7] mmol/L, P〈0. O1 ; 137.6 ±8.8] vs 124.8 ±9.6] g/L, P〈0.01）, but not in the TUERP group. Three months after opera-tion, IPSS, QOL, and Qmax were all markedly improved in both groups （P 〈 0.01 ）, but with no significant differences between the two groups （P 〉 0.05 ）. Conclusion ： TUERP is better than TURP in the treatment of BPH for its advantages of higher resection rate of the prostate, shorter operation time and bladder irrigation time, less intraoperative blood loss, fewer postoperative complications, and faster recovery.