经尿道前列腺剜除术治疗重度前列腺增生46例

目的探讨经尿道前列腺剜除术在重度前列腺增生症治疗中的手术方法及应用价值。方法在经尿道前列腺剜除术中应用电切镜鞘在外科包膜与增生的腺体之间存在的层面剥离增生的前列腺体,完成剥离后再按顺序分叶切除,通过临床46例的观察,对手术安全性、并发症和效果进行观察分析。结果在经尿道前列腺剜除术中经过剜除的增生腺体,血供基本被切断,术中出血少,外科包膜清楚,视野清晰,利于快速切除,切除速度明显提高。46例均顺利完成手术,1例患者术中需输血,无电切综合征,无死亡病例。术后3个月IPSS、QOL评分、最大尿流率、膀胱残余尿均较术前明显改善(p<0.01)。46例随访12～16个月,平均13.5月,无一例患者在随访期间需行第二次手术,无膀胱颈挛缩、无永久性尿失禁,有一例出现前尿道狭窄,经尿道扩张后恢复。结论经尿道前列腺剜除术是治疗重度前列腺增生的安全、有效的手术方案,值得临床推广。

TRANSURETHERAL ENUCLEATION OF PROSTATE FOR 46 CASES OF SEVERE BENIGN PROSTATE HYPERPLASIA

Objective To discuss the operation method and application of transurethral enucleation of the prostate in treatment of benign prostatic hyperplasia.Methods During the process of transuretheral enucleation of prostate the hyperplastic gland was peeled off from the surgical envelope of prostate by the resectoscope sheath,and then the gland was resected step by step.Based on the data of 46 cases,the safety,complication and effect were evaluated. Results During the process,after enucleation,the blood supply of the hyperplasia gland was reduced and the surgical envelope was clear,which facilitated the rapid resection.46 patients underwent the procedure successfully, there was on transurethral resection syndrome,no death,but one case needed blood transfusion.3 months after operation,the IPSS,QOL,peak -flow and bladder residual urine were all improved obviously(p<0.01).During the follow -up for 12 ~ 16 months,there were on re - operation,bladder neck contracture,permanent urinary incontinence in these cases,but anterior urethral stricture happened to one patient,and recovered after urethral sounding. Conclusion Our experience suggested that the transuretheral enucleation of prostate is the safe and effective procedure for severe benign prostate hyperplasia,which would be popularized in clinical practice.