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。

Various methods of transurethral plasmakinetic resection of prostate for the treatment of BPH ( Report of 1900 cases)

Objective To evaluate the surgical efficacy and methods of transurethral plasmakinetic resection of prostate （PKRP） for the treatment of benign prostatic hyperplastia （BPH）. Methods According to the volume of the hyperplastic prostate and whether the prostate adhesion with capsule or not, the 1900 patients were performed intracavitary anterograde resection or retrograde enucleation of the prostate with bipolar plasmakinetic generation. There were 253, 449, 912 and 286 cases performed by the methods of simple anterograde resection of prostate, divided anterograde resection of prostate, divided retrograde enucleation of prostate and total retrograde enucleation of prostate respectively. Results All Of the 1900 cases underwent the procedure uneventfi.tlly. Operative time was 20-95 min with the average of （78±27）min. The weight of resected tissue was 8-200 g with the average of （63±23）g .There were no transurethral resection syndrome, intestinal perforation, bladder perforation. During the follow-up of 12-48 months, 83 cases had short term urinary incontinence, 1 secondary bleeding, 54 urethral stricture, 4 bladder neck contracture, 3 recurrence of BPH. There was significant difference of IPSS, QOL, Qmax before and after treatment （P〈 0.01）. Conclusions It is suggested that PKRP is effective and safe. It can widen chnical indications and decrease surgical complications by various methods of transurethral resection of prostate.