Madigan前列腺增生切除术

为了提高前列腺增生症的手术治疗效果，采用Ｍａｄｉｇａｎ手术治疗前列腺增生症患者２５例。１５例尿道完整，１０例损伤尿道缝合修复；术后出血少、恢复快；随访４～２５个月，无尿道狭窄、尿失禁等并发症。对手术优点、术中注意事项及适应证的选择进行了讨论。     

Madigan前列腺切除术

目的：总结Ｍａｄｉｇａｎ前列腺切除术治疗前列腺增生症（ＢＰＨ）的经验。方法：回顾性分析２６例ＢＰＨ患者的临床资料。结果：２１例尿道完整,２例膀胱颈和５例尿道损伤后均缝合修复。术后随访３－２５个月,无尿道狭窄,,尿失禁,性功能丧失等并发症。结论;本术式适应证为以侧叶增生为主,中叶无明显增生,无膀胱内疾病,未接受过射频,微波,注射及电切等治疗的ＢＰＨ患者。     

改良 Madigan 前列腺切除术在临床的应用(附53例报告)

为了提高前列腺切除术的治疗效果，１９９３年９月～１９９６年５月对５３例前列腺增生症患者采用改良Ｍａｄｉｇａｎ前列腺切除手术。术前留置尿管后作ＣＴ检查，按ＣＴ测量前列腺体积计算重量并分度，了解尿道走向。手术特点为锐性分离前列腺与尿道、膀胱颈之间的组织及前列腺包膜，切除增生的腺体组织，保留完整尿道与膀胱颈。术后恢复快，并发症少，随访１～３２个月，疗效满意。对手术操作要点及适应证进行了讨论。     

前列腺增生术后前列腺癌9例报告

目的:探讨BPH切除术后前列腺癌的临床特点。方法:报告9例BPH切除术后前列腺癌患者的临床资料。前列腺癌发病距BPH手术时间为0.5~8年,平均4.6年。患者BPH术后主要因尿频、排尿困难、肉眼血尿或骨痛而再次就诊。血清PSA异常8例,前列腺结节5例,同位素扫描(ECT)骨转移1例。9例均行最大限度雄激素阻断治疗,1例骨痛者行辅助放疗。结果:7例获随访0.5~8年,其中死亡2例,病变稳定4例,病变进展1例。结论:BPH切除术后的病例仍有发生前列腺癌可能,术后应定期随访,及早发现术后前列腺癌。血清PSA、直肠指检及前列腺穿刺活检是BPH术后前列腺癌诊断的主要方法;早期可行前列腺癌根治术,晚期或转移者则以内分泌治疗为主。     

腔内手术与开放手术治疗前列腺增生的疗效比较

目的探讨经尿道腔内手术及传统开放手术治疗前列腺增生症(BPH)的彻底性,对比不同方法的疗效.方法将BPH患者126例,随机分成腔内组和开放组.测量切除腺体重量及术前B超估计重量,求得腺体切除率.术后3个月随访,根据IPSS评分、最大尿流率、并发症和住院时间等,比较两类术式的疗效.结果腔内组95例,平均切除腺体(25.8±16.7) g,平均腺体切除率61.4%;开放手术组31例,平均切除(39.6±30.8) g,平均腺体切除率70.8%;手术疗效二组间差异无显著性意义(P＞0.05).而术后住院时间等,腔内组明显短于开放组(P＜0.05).结论腔内手术近期疗效与开放手术类似,效果好,并发症少,但对增生腺体切除率偏低,可能影响远期疗效.等离子双极汽化前列腺切除术采用腔内分隔切开逆行剥离法切除增生腺体,有望达到开放手术顺行剥离切除腺体的效果.     

The costs of prostatectomy for benign prostatic hyperplasia

Using claims data for a 5% random sample of Medicare beneficiaries, we estimated the costs of surgical treatment for benign prostatic hyperplasia (BPH), including those related to the initial prostatectomy, the treatment of postsurgical complications, and reoperation within one year. We identified 14,480 men who underwent prostatectomy for BPH during 1986–1987, including 13,730 transurethral and 750 open procedures. Mean total inpatient costs (including all hospital charges and professional service fees) for these procedures were estimated to be $6,501 and $10,223, respectively. Among patients who underwent transurethral and open prostatectomy, we identified 938 (6.8%) and 39 (5.2%) individuals who had at least one readmission for postsurgical complications or reoperation. Total expected costs of transurethral and open prostatectomy, inclusive of readmissions for complications and reoperations within one year, were estimated to be $6,823 and $10,477, respectively. Our study indicates the economic burden represented by surgical treatment of BPH. © 1993 Wiley-Liss, Inc.     

巨大BPH开放手术治疗25例

治疗BPH的方法众多。随着经尿道前列腺电切技术（TURP）的13益成熟。TURP已成为当前外科治疗BPH的主要手术方式,被誉为外科治疗BPH的“金标准”。对于巨大的BPH．笔者还是主张开放手术。自1993年1月至2007年12月,笔者对25例巨大的BPH病人实施开放手术,取得了较为满意的治疗效果。现报告如下。     

腹腔镜下耻骨后腹膜外保留尿道的前列腺切除术

目的探讨腹腔镜下经耻骨后腹膜外保留尿道的前列腺切除术治疗大腺体前列腺增生症的可行性。方法自2006年1月至2007年1月对9例前列腺增生症的病人采用腹腔镜行耻骨后腹膜外前列腺切除术,病人年龄为(77.8±6.8)岁,范围为(62～83)岁。经直肠前列腺B超显示前列腺大小为(101.3±36.2)g,范围为(62～172)g,均无明显中叶增生。腹腔镜手术包括耻骨后腹膜外腔的建立、排列成倒U字形5个穿刺套管的放置、前列腺被膜的切开、增生腺瘤的切除、前列腺部尿道的保护及前列腺被膜的缝合等主要步骤。结果9例病人手术顺利,术中出血(190±160.6)ml,范围为(60～600)ml,手术时间为(174±59.8)min,范围为(90～240)min。术后恢复顺利,尿管拔除时间为(8.4±3.8)d。术后3月复查病人尿流率、国际前列腺症状评分(IPSS)评分、生活质量评分(QOL)等较术前明显好转。术前有性功能的4例病人术后性功能无损。结论对腺体大的前列腺增生症行腹腔镜下经耻骨后腹膜外行前列腺切除术是可行的,病人创伤小、恢复快、效果满意。     

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia

Objective

Laparoscopic simple prostatectomy for large volume benign prostatic hyperplasia (BPH) has been reported in the literature and may be a viable alternative to open surgery for large prostate glands. While previous publications have shown comparable outcomes between laparoscopic and open simple prostatectomy, there have been few publications describing improved laparoscopic operative technique to further improve these outcomes. The authors describe a novel technique of prostatic urethra preservation during laparoscopic simple prostatectomy.

Materials and methods

From January 2006 to September 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 51 patients with symptomatic BPH. This technique included extraperitoneal insufflation of the retropubic space by balloon dilation, placement of five trocars in an inverted U shape, transverse prostatic capsular incision, development of a subcapsular plane, and removal of prostatic adenoma with preservation of the prostatic urethra followed by suturing of the prostatic capsule. Demographic, perioperative and outcome data were recorded.

Results

The mean operative time was 126±51.98 min and the estimated blood loss was 232.55±199.54 mL. Significant improvements were noted in the International Prostate Symptom Score (IPSS), quality of life (QOL) questionnaires and maximum flow rate (Q_max) of patients three months after surgery. No incontinence was reported in any patient. Moreover, there was no significant difference in the 5-Item International Index of Erectile Function (IIEF-5) score pre- and post- operatively in patients who had erectile function before surgery and no patient complained of retrograde ejaculation during the postoperative follow-up period.

Conclusions

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia is feasible and reproducible. With this technique, postoperative morbidity can be reduced and antegrade ejaculation preserved.KEY WORDS : Benign prostatic hyperplasia, laparoscopy, prostate, prostatectomy     

腹腔镜治疗良性前列腺增生研究进展

良性前列腺增生症是老年男性的常见病与多发病,手术治疗作为BPH的治疗方法已有很成熟的发展,并且随着医学技术的不断发展,越来越多的术式被应用。本文就目前腹腔镜在良性前列腺增生症中的应用作一初步探讨。     

Madigan手术103例报告

目的 提高良性前列腺增生症开放手术治疗效果。方法 采用耻骨后保留尿道前列腺增生部切除术治疗良性前列腺增生症患者１０３例。结果 １０３例均手术成功,随访１～５６个月,效果满意,并发症少。结论 耻骨后保留尿道前列腺增生部切除术为较理想的良性前列腺增生开放手术治疗方法。     

Evaluation for Madigan＇s prostatectomy in patients with benign prostatic hyperplasia

Aim: To comparatively evaluate the efficacy and post-operative complications of the Madigan‘s prostatectomy (MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasia were divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symptom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The International Continence Society (ICS) nomogram, Abrams-Gfiffiths (AG) number and linear passive urethral resistance relation analysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamic parameters before and after operation, as well as the advantages and post-operative complications were recorded and compared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urodynamic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantages of the absence of postoperative hematuria and post-catheter stricture, a shorter period of hospitalization, and lower incidence of retrograde ejaculation and erectile dysfunction. Conclusion: Both MPC and SPPC can effectively relieve BOO. MPC has certain advantages and a lower incidence of complications as compared with SPPC.     

Evaluation for Madigan's prostatectomy in patients with benign prostatic hyperplasia

Aim: To comparatively evaluate the efficacy and post-operative complications of the Madigan's prostatectomy(MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasiawere divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symp-tom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The InternationalContinence Society (ICS) nomogram, Abrams-Griffiths (AG) number and linear passive urethral resistance relationanalysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamicparameters before and after operation, as well as the advantages and post-operative complications were recorded andcompared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urody-namic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantagesof the absence o     

良性前列腺增生患者经尿道电切术后再次手术的病理组织学特征分析

目的分析再次TURP患者前列腺组织VEGF、AR的表达,探讨其在再次TURP发生中的作用及意义。方珐选取有再次TURP手术史（再次TURP组）和仅有一次手术史（对照组）的BPH患者各50例。采用免疫组织化学sP法检测前列腺组织中CD34、VEGF、AR的表达,计算MVD值及VEGF、AR指数,并对再次TURP组首次标本和对照组标本、再次TURP组两次手术标本分别进行比较及统计学分析。结果再次TURP组首次标本、再次标本及对照组中MVD值分别为：35．83±20．92、32．16±16．65、20．56±6．99;VEGF指数分别为：7．55±2．72、7．06±2．36、4．28±2．62;AR指数分别为：6．17±1．86、6．99±2．44、4．16±1．34。再次TURP组首次标本MVD值、AR、VEGF指数均高于对照组,两组差别有统计学意义（P〈0．05）;而再次TURP组前后两次手术标本间各指标差别无统计学意义（P〉0．05）。相关分析发现,AR指数和VEGF指数、VEGF指数和MVD值、AR指数和MVD值之间均存在正相关。结论BPH患者前列腺组织中高MVD值及AR、VEGF的高表达是导致其TURP术后复发及再次手术的重要原因之一,可作为判断术后复发的危险因素及采取针对性预防措施的指标。     

Prognosis of the prostatectomy of benign prostatic hyperplasia

Surgery of benign prostatic hyperplasia has been performed in 484 cases during a period of 10 years from January 1978 to December 1987; these 484 cases comprised 345 to transurethral resection, 130 of subcapsular extirpation and 9 of cryosurgery. Their period of prognosis was examined; 10-year survival rate was 88.9, 95.7, 60.4, 55.8 and 42.8% for 55-59, 60-64, 65-69, 70-74 and 75-79 years, respectively, 8-year and 7-year survival rates being 31.7 and 66.7% for 80-84 85-89 years, respectively. Survival rate by age bracket was compared in terms terms of electrocardiogram (ECG), pulmonary function and possible anomalies and operative blood transfusion. The group of patients with abnormal ECG and pulmonary function showed a significant decreasing survival rate with aging. The aged patients showed no difference in survival rate according to possible blood transfusion. Examination of the cause of death revealed predominant involvement of cardiopathy and cerebrovascular disorder, with comparatively less due to cancers. In terms of postoperative conditions of life of these patients and a long period prognosis of their urination, more 75% of them are living in good condition and 70% are in a state of satisfactory urination.     

Open prostatectomy for benign prostate hyperplasia: short-term outcome in 3000 consecutive patients

The purpose of this study was to report the short-term results of open prostatectomy for benign prostatic hyperplasia (BPH). Patient charts were retrospectively reviewed from September 1988 to April 2004. A total of 3000 consecutive patients with bothersome lower urinary tract symptoms (LUTS) and complications of BPH underwent open prostatectomy in our center. We routinely used a retropubic, transcapsular approach with spinal anesthesia. Mean age was 69 years. Three hundred and sixty one patients were 80 years or older. Mean prostate volume was 71 ml. One thousand eight hundred and twenty five patients (60.8%) presented with and were operated on for acute urinary retention (AUR), and 350 patients (11.7%) presented with and were operated on for urge/overflow urinary incontinence. The main reasons for delayed presentation were poverty and absence of real medical insurance, because in Iran 'insured' patients pay at least 60% of their medical expenses personally. Reoperation in the same admission was needed in 29 patients (1%). Transfusions were needed in 99 patients (3.3%). Wound infection occurred in 37 patients (1.2%). Acute myocardial infarction (MI) occurred in 15 patients (0.5%), resulting in three deaths. Occurrence of AUR had significant negative correlation with duration of symptoms (P<0.05; odds ratio 0.5), and significant positive correlation with positive urine culture (P<0.05; odds ratio 2.7). Duration of hospital stay had significant positive correlation with positive urine culture (P<0.05; odds ratio 1.6) and advanced age (P<0.05; odds ratio 1.8), and significant negative correlation with prostate volume (P<0.05; odds ratio 0.6). Our results are representative of the current status of open prostatectomy. Whenever minimally invasive therapies are not affordable retropubic prostatectomy is a practical alternative.     

经腹途径机器人辅助前列腺增生切除术初步经验

目的探讨经腹途径机器人辅助前列腺增生切除术(robotic-assisted simple prostatectomy,RASP)治疗大体积良性前列腺增生的手术经验、临床安全性及可行性。 方法回顾性分析2017年1月至2021年1月期间,首都医科大学附属北京安贞医院行RASP治疗的21例前列腺增生患者临床资料,对手术程序、术中和术后所存在的问题进行总结。 结果21例患者均顺利完成手术,无中转开放手术;平均手术时间(135.7±23.2)min,平均术中出血量(168.4±21.5)ml,无输血,术后24 h内停止膀胱冲洗,拔除造口管时间为术后2 d,拔除引流管时间为术后3 d,平均拔除尿管时间(12.5±2.4)d。术后3个月复查残余尿量、最大尿流率和国际前列腺症状评分均有改善,差异有统计学意义(P<0.01)。 结论RASP治疗大体积良性前列腺增生是一种安全、有效的微创方法,可能成为大体积良性前列腺增生的可选治疗手段。     

经尿道选择性绿激光汽化治疗前列腺增生

目的：探讨经尿道选择性绿激光前列腺汽化术（PVP）治疗BPH的有效性和安全性。方法：采川PVP治疗BPH患者156例,并对手术前后相关指标进行比较观察。结果：156例手术均顺利,手术时间平均（44.5±23.8）min,术中出血量（43.2±16.4）ml,无输血病例。术后32例未留置尿管,余124例留嚣尿管时间12～36h,平均（15.2±4.6）h;拔除尿管后排尿均通畅,无尿失禁等并发症发生。术后随访4～14个月,围际前列腺症状评分（IPSS）由术前28.6±2.4下降至术后6.4±0.6,最大尿流率由术前平均（5.3±0.5）ml/s升至术后（19.1±1.8）ml/s;生活质量评分（QOL）由术前平均5.4±0.6下降至术后1.2±0.7,剩余尿量山术前（254.6±69.7）ml下降至术后（20.5±4.6）ml。手术前后比较差异均有统计学意义（P〈0.05）。结论：PVP治疗BPH疗效显著,并发症少。安全性高,是一种理想的微创手术。     

Suprapubic and retropubic prostatectomy for prostatic hyperlasia.

The historical aspects, preoperative evaluation including preoperative note and postoperative flow sheet examples, and the surgical techniques of suprapubic and retropbuic prostatectomies are described in detail. These procedures allow relief from symptomatic prostatic hyperplasia with minimal morbidity and mortality.