TUVP配合TURP治疗前列腺增生症98例报告

目的：探讨前列腺增生症的有效治疗方法。方法;采用经尿道前列腺电气化术配合经尿道前列腺切除术治疗ＢＰＨ９８例。结果：术中未输血;术后随访６－１８个月,效果满意,均排尿通畅,并发症少。结论;本方法操作简易,出血少,能扩大手术适应证。     

个体化TURP治疗高危良性前列腺增生症的临床观察

目的 探讨个体化方案治疗高危良性前列腺增生症的临床效果及安全性.方法 对87例高危良性前列腺增生症患者进行个体化围手术期处理,采用标准经尿道前列腺切除术(TURP)(22例)、低容量大通道TURP(37例)和低容最小通道TURP(28例)手术治疗,观察手术治疗效果及安全性.结果 全部病例均顺利耐受手术,无严重并发症,无输血病例.标准TURP组、低容量大通道TURP组和低容晕小通道TURP组平均手术时间分别为(65.5±21.2)、(32.4±1 7.5)和(16.5±3.6)min;术中平均失血量分别为(148.4±45.3)、(84.7±37.2)和(32.4±15.7)ml;平均切除组织量分别为(41.2±10.5)、(25.4±6.3)和(1 1.3±3.2)g.后两种方法与标准TURP组相比,差异有统计学意义(P＜0.05).所有病例随访3～28个月,国际前列腺症状评分(IPSS评分)分别降低(19.7±6.8)、(17.9±6.4)和(15.7±9.5)分;最人尿流率分别增加(13.4±8.4)、(12.7±9.4)和(11.4±5.4)ml/s;生活质量评分(QOL)分别下降(2.2±0.2)、(2.1±0.2)和(2.4±0.4)分;剩余尿量(RUV)分别下降(135.7±68.4)、(158.8+87.5)、(147.6±65.7)ml.组间疗效比较差异无统计学意义(P＞0.05).结论 个体化围手术期治疗和个体化TURP是治疗高危BPH的安全有效方法,值得推广.     

TUVP结合TURP治疗前列腺增生45例报告

目的：探讨治疗前列腺增生（BPH）的有效手术方法。方法：采用经尿道前列腺电气化术（TUVP）结合经尿道前列腺切除术（TURP）治疗BPH45例。结果：术中出血少,术后随访3－6个月,排尿功能均恢复良好,国际前列腺症状评分（IPSS）平均9．2分,生活质量评分（QOL）平均1．5分,最大尿流率（Qmax)平均14．1ml/s,未出现严重并发症。结论：本方法是一种操作较简易、出血少、安全性高、疗效确切的新手术方法。     

经尿道等离子体切割术治疗前列腺增生

我院2003年3月～2004年9月采用经尿道等离子体前列腺切割术(TUPKVP)治疗良性前列腺增生症(BPH)患者82例,效果满意.现报告如下.     

TUVP与TURP联合应用治疗良性前列腺增生

目的 :探讨治疗良性前列腺增生 (BPH)的有效方法。　方法 :联合应用经尿道前列腺电汽化术 (TUVP)与经尿道前列腺电切术 (TURP)治疗BPH 179例病人。　结果 :179例病人住院时间 6～ 12d ,平均 5 .5d。术后随访 6～ 36个月。国际前列腺症状评分 (IPSS)由术前的 2 9.0分下降到 7.6分 (P <0 .0 5 ) ;最大尿流率 (Qmax)从术前的 5 .81ml/s上升到 14 .8ml/s(P <0 .0 5 )。　结论 :联合应用TUVP与TURP治疗BPH是安全、有效的方法。     

经尿道前列腺等离子双极电切与TURP治疗BPH的疗效比较

目的:比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗BPH的临床疗效及安全性。方法:将164例BPH患者随机均分成PKRP组和TURP组,比较两组术后最大尿流率(Qmax)、剩余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标。结果:PKRP组72例、TURP组76例获得随访,随访时间3个月。PKRP组尿道外口狭窄2例,膀胱颈挛缩1例,TURP组尿道外口狭窄6例,膀胱颈挛缩4例;PKRP组Qmax为(22.6±4.6)ml/s,PVR为(8.6±4.4)ml,IPSS为(4.6±1.2)分,QOL为(1.2±0.6)分;TURP组分别为(24.2±4.2)ml/s、(9.6±3.6)ml、(4.4±1.0)分、(1.4±0.8)分,两组比较差异有统计学意义(P<0.05)。结论:PKRP与TURP治疗BPH疗效相近,但PKRP平均手术时间、术中出血量、围手术期及术后并发症较TURP明显减少,手术安全性高,有良好的应用前景。     

等离子电切术中不同方法治疗前列腺增生症（附1900例报告）

目的探讨经尿道等离子前列腺电切术（PKRP）治疗前列腺增生症（BPH）的方法和疗效。方法对1900例BPH患者根据前列腺大小及其与包膜粘连情况,253例采用单纯顺行电切法,449例采用分割顺行电切法,912例采用分割逆行剜除法,286例采用完全逆行剜除法进行PKRP。结果四种方法手术均顺利进行,PKRP手术时间20～195min,平均（78±27）min。切除腺体组织8-200g,平均（63±23）g。术中无电切综合征、直肠穿孔、膀胱穿孔发生,1762例获得随访,平均随访时间为（37±6．4）个月。术后短期尿失禁83例、继发出血1例、尿道狭窄54例、膀胱颈挛缩4例、增生复发3例、术后住院期间死亡1例。术后6个月,国际前列腺症状评分、生活质量评分、最大尿流率均较术前明显改善（P〈0．01）。结论PKRP治疗BPH安全有效,再根据腺体大小及其与包膜粘连情况等,采用不同方法电切,能拓宽前列腺电切适应证,降低并发症。     

PKRP与TURP治疗良性前列腺增生症的疗效比较

目的观察经尿道前列腺等离子切除术（PKRP）治疗良性前列腺增生症（BPH）的疗效及并发症,并与经尿道前列腺电切术（TURP）进行比较。方法回顾分析采用PKRP、TURP治疗的768例BPH患者,分别收集两组患者年龄、国际前列腺症状评分（IPSS）、剩余尿量（RUV）、最大尿流率（Qmax）、生活质量评分（QOL）、手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率资料并进行统计分析。结果两组病例年龄、前列腺重量及术前IPSS、RUV、Qmax和QOL比较差异均无统计学意义（P〉0.05）。两组在手术成功率、平均住院时间、术后平均留置尿管时间、术中出血量和冲洗时间方面无统计学差异（P〉0.05）;两组在手术时间、并发症发生率方面有统计学差异（P〈0.05）。结论PKRP治疗BPH的近期临床疗效与TURP相当,临床上可根据患者情况和适应证选择不同方法,以获得更好的临床疗效。     

经尿道单极前列腺剜除术与经尿道等离子前列腺剜除术的疗效及安全性比较

目的探讨经尿道单极前列腺剜除术与经尿道等离子前列腺剜除术的疗效及安全性比较。方法在2006年11月1日至2010年8月1日确诊为前列腺增生（BPH）的男性患者75例,符合纳入标准的患者随机分成两组,因前列腺包膜与腺体粘连紧密无法行剜除术3例,退出试验。经尿道单极前列腺剜除术组（TUERP）34例与经尿道等离子前列腺剜除术组（PKERP）38例,比较两组的手术时间、术中出血量、术后留置导尿管时间和术后住院时间,两组术后3个月与术前国际前列腺症状0PSS）、生活质量（QOL）评分及最大尿流率（Qmax）检查、残留尿量（RUV）、前列腺重量进行比较。结果两组间各项观察指标经独立样本t检验,差异无统计学意义（P〉0．05）;各项观察指标手术前后比较,经配对t检验,差异有统计学意义（P〈0．05）。结论在保证手术技巧娴熟前提下,TUREP术与PKERP术相比,同样能够缩短手术时间、减少术中出血量、缩短术后留置导尿管时间和术后住院时间,其有效性和安全性相近,值得推广实行。     

经尿道前列腺等离子双极电切术与普通电切术中失血量比较

目的比较经尿道前列腺等离子双极电切术与普通电切术中失血量。方法自2007年10月至2008年3月,收治的30例BPH患者行经尿道等离子双极电切（PKRP）;自2008年4月至7月,收治的30例BPH患者行普通电切（TURP）。分析这60例患者的临床资料。PKRP组年龄（74．2±7．0）岁,前列腺体积（49．3±33．1）ml;TURP组年龄（73．2±7．2）岁,前列腺体积（51．1±23．2）ml。收集术中所有冲洗液,测冲洗液体积,混匀后精确测血红蛋白浓度。结果PKRP组手术时间（111．3±42．5）min,切除前列腺组织重量（20．1±14．3）g,失血量（86．3±79．9）ml,每克前列腺组织平均失血量（3．7±1．9）ml／g;TURP组手术时间（108．0±42．2）min,切除前列腺组织重量（23．6±13．1）g,失血量（201．8±178．7）ml,每克前列腺组织平均失血量（8．3±6．1）ml／g。PKRP组和TURP组手术时间及切除前列腺组织重量差异无统计学意义（P〉0．05）。PKRP组术中失血量少于TURP组（P〈0．01）。PKRP组每克前列腺组织平均失血量少于TURP组（P〈0．01）。结论经尿道前列腺等离子双极电切术中失血量少于普通电协。     

Transurethral vaporization-resection of the prostate versus standard transurethral prostatectomy: comparative changes in histopathological features of the resected specimens

OBJECTIVES: Transurethral vaporization resection of the prostate (TUVRP) is a recent modification of the standard transurethral resection of the prostate (TURP). TUVRP uses a band electrode coupled to a high electrocuting energy to achieve simultaneous resection, vaporization and coagulation of the prostate. We evaluated the histopathological resection specimens of patients treated with TUVRP to see whether the higher energy used will result in thermal artifacts that will interfere with the pathological evaluation of the prostate, and compared the results to TURP specimens. MATERIAL AND METHODS: The histopathological specimens of 50 patients that underwent TUVRP or TURP were reviewed. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes or areas of stromal coagulative necrosis. Each identified pattern was awarded 1 point. The severity of cautery artifact was graded into mild, moderate or severe according to the sum of points in each specimen. RESULTS: Mild cautery artifact changes were noted in 1 patient who underwent TURP. Moderate changes were noted in 21 patients in each TURP and TUVRP groups while severe changes were noted in 4 and 3 patients undergoing TUVRP and TURP respectively. There were no statistically significant differences between the groups with regard to the severity of the cauterization- induced changes. CONCLUSIONS: The quality of histopathological specimens produced by TUVRP is similar to the standard TURP. It seems that the higher energy use in electrovaporization technique does not result in greater thermal injury to the tissues possibly because of the cooling effect of the irrigation fluids used intraoperatively.     

Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer

PURPOSE: We assessed the rate and results of transurethral resection of the prostate (TURP) in patients previously treated with brachytherapy as monotherapy for localized prostate cancer. MATERIALS AND METHODS: From May 1998 to May 2003, 600 patients with localized prostate cancer were treated with brachytherapy at our institution. Brachytherapy was performed as monotherapy with curative intent for clinically localized prostate cancer without adjuvant treatment in patients with clinical stages T1c (68.4%) or T2a (31.6%) disease. -Iodine and palladium implants were used in 583 and 7 patients, respectively. A real-time interactive implantation technique was used in all but the first 17 patients, who were treated using a preplanned technique. RESULTS: Of the 600 patients 19 (3.1%) underwent TURP after brachytherapy. Among the patients with acute urinary retention the median interval between prostate brachytherapy and urinary retention was 2 months (range 0.5 to 32). No TURP was done within 6 months after implant. The median interval between prostate brachytherapy and TURP was 7 months (range 6 to 41) and median prostate specific antigen (PSA) before TURP was 0.5 ng/ml (range 0.04 to 3.4). In the 19 patients the median weight of resected prostatic tissue was 8 gm (range 2 to 19) and 1 to 11 seeds were removed (median 5). The perioperative and postoperative courses were uneventful. There was no TURP related incontinence. With a median followup of 28 months after brachytherapy (range 7 to 48) no patient had clinical or biochemical evidence of disease progression, and for the group of 19 patients who underwent TURP median serum PSA at the end of followup was 0.38 ng/ml (range 0.03 to 3.4). CONCLUSIONS: After brachytherapy as monotherapy, TURP can be done safely if indicated. In our experience the resection of prostatic tissue along with a limited number of seeds at least 6 months after implantation did not impair PSA based biological and clinical results of brachy-therapy.     

三种经尿道前列腺切除术治疗良性前列腺增生的疗效比较

目的比较良性前列腺增生（BPH）的三种经尿道手术治疗效果。方法分别采用经尿道前列腺电切术（TURP）、经尿道双极等离子前列腺切除术（PKRP）和经尿道铥激光前列腺切除术（TmLRP）治疗BPH共137例。结果三种术式患者手术前后前列腺症状评分（IPSS）、生活质量评分（QOLs）、残余尿（RUV）、最大尿流率（Qmax）比较均得到显著改善（P〈0．01），疗效满意。前列腺重量（PW）〈40g时，TmLRP组手术时间明显短于PKRP和TURP组（P〈0．01）。PW〉50g时，TmLRP组手术时间明显长于PKRP和TURP组（P〈0．01）。TmLRP和PKRP组术中出血少，术后膀胱冲洗时间、留管时间及住院时间均短于TURP组（P〈0．01）。站论三种经尿道手术方法均是治疗BPH的有效手段，TmLRP和PKRP比TURP更安全，术中及术后并发症更少。     

良性前列腺增生再次经尿道前列腺切除术116例临床分析

目的分析良性前列腺增生(BPH)再次经尿道前列腺切除术(TURP)的原因,并总结临床诊治体会。方法1990年12月-2006年5月,我院收治因BPH行TURP术患者116例。对本组二次住院TURP治疗的临床资料及二次出院后的随诊资料进行回顾分析。结果116例中,初次手术时因高龄高危而选择姑息通道手术者71例(61.2%),前列腺体积大于60mL者83例(71.5%),术中切穿包膜或静脉窦而中止手术者5例(0.4%)。再入院原因,单纯排尿困难46例(39.7%),反复血尿10例(8.6%),排尿困难合并血尿52例(44.8%),排尿困难和(或)血尿同时合并下尿路感染8例(6.9%)。二次入院后经B超及电切镜检查,皆证实有前列腺组织残留或同时合并腺体再增生,再次行TURP治疗。切除残留腺体、再增生腺体。再次手术出院后随访108例,疗效满意94例(87.0%)。结论BPH再次TURP主要由于高龄高危患者、前列腺体积较大、组织残留较多或再增生以及在此病理基础上的继发出血、下尿路感染。再次TURP手术疗效良好。     

经尿道前列腺电切与汽化切除术的疗效比较

目的 对比分析经尿道前列腺电切(TURP)和经尿道前列腺汽化切除术(TUVRP)的疗效和手术并发症.方法 良性前列腺增生(BPH)患者637例,随机分为TURP组(298例)和TUVRP组(339例).患者术前最大尿流率(Qmax)和国际前列腺症状评分(IPSS)分别为(9.8±2.3)、(10.1±2.1)ml/s和15.3±3.1、15.1±3.7.比较2组患者手术时间、失血量、血钠变化及手术并发症发生率.结果 2组手术均顺利,无手术死亡病例.TURP和TUVRP组术后Qmax分别为(19.0±2.9)和(18.0±2.3)ml/s,IPSS 5.0±1.4和8.05±1.6,与术前比较差异均有统计学意义(P<0.01),2组问Qmax差异无统计学意义(P0.05)、IPSS差异有统计学意义(P<0.05).TURP组手术时间(52±16)min,肉眼血尿持续(9.0±2.3)d,继发性出血6例(2.0%),尿路感染14例(4.7%),下尿路症状(LUTS)26例(8.7%),暂时性尿失禁6例(2.0%),膜部尿道狭窄4例(1.3%);TUVRP组分别为(68±19)min,(12.0±3.6)d,19例(5.6%),38例(11.2%),59例(17.4%),13例(3.8%),16例(4.7%);以上各项2组间比较差异均有统计学意义(P值均<0.05).TURP组术中失血量(126±29)ml,切除组织(31±8)g,手术前后血钠差(8±6)mmol/L,发生TURS 3例(1%);TUVRP组分别为(122±38)ml,(33±9)g,(7±7)mmol/L,2例(0.6%);以上各项2组间比较差异均无统计学意义(P值均0.05).结论 TURP和TUVRP均为治疗BPH的有效手术方法,TURP手术并发症发生率更低.     

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 holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients

PURPOSE: Transurethral electrocautery resection (TURP) is generally regarded as the gold standard surgical treatment for bladder outflow obstruction due to benign prostatic hyperplasia despite its rather high morbidity. The high powered holmium:YAG laser can be used endoscopically to enucleate obstructing prostatic tissue in a relatively bloodless manner. The technique of transurethral holmium laser enucleation of the prostate (HoLEP) was compared to standard TURP for the surgical management of prostate adenomas in a randomized, prospective clinical trial. MATERIALS AND METHODS: A total of 200 urodynamically obstructed patients with a prostate of less than 100 gm on transrectal ultrasound were randomized to HoLEP or TURP. All patients were assessed preoperatively, and 1, 6 and 12 months postoperatively. Patient baseline characteristics, perioperative data and postoperative outcome were compared. All complications were noted. RESULTS: HoLEP was significantly superior to TURP in terms of catheter time, hospital stay and hemoglobin loss but operative time was longer. HoLEP and TURP resulted in a significant improvement in American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes with symptoms scores and residual volume significantly better in the holmium group. Effects on continence and potency were similar in the 2 groups but adverse events were less frequent in the holmium group. CONCLUSIONS: HoLEP and TURP are highly effective procedures for removing obstructing prostatic adenomas. HoLEP resulted in significantly better micturition parameters and less perioperative morbidity.     

经尿道前列腺等离子双极电切和经尿道前列腺电切治疗良性前列腺增生的临床结果比较

目的比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的临床疗效及安全性。方法PKRP组78例,TURP组78例,比较2组手术时间、术中出血量,术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)及并发症发生率。结果PKRP组手术时间、术中出血量、术后2个月内暂时性尿失禁发生率、术后4周内继发性出血及3个月内尿道狭窄发生率分别为(64±21)min,(247±84)ml,26．9％(21／78),1．3％(1／78)和2．6％(2／78),TURP组分别为(78±18)min,(432±132)ml,48．7％(38／78),10．3％(8／78)和12．8％(10／78),2组比较差异均有统计学意义(P<0．05)。2组均未发生电切综合征(TURS)。PKRP组术后IPSS为4．6±1．2,QOL为1．1±0．8,Qmax为(26．1±4．6)ml／s; TURP组分别为4．8 4±1．1、1．3±0．8、(25．3．4±4．2)ml／s;均较术前明显改善(P<0．01),但组间差异无统计学意义。结论PKRP与TURP比较,治疗BPH疗效相近,但安全性更好,是治疗BPH的理想方法。