经尿道腔内剜除法联合选择性膀胱颈切除治疗小体积前列腺增生症

目的 介绍我们经尿道治疗小体积前列腺增生的方法，并总结其疗效。 方法 42例体积≤30ml前列腺增生患者，采用经尿道腔内剜除法切除增生前列腺；以剥离面为参照，切平5~7点处颈口组织，切断3~4点、8~9点处纤维环。行颈口切除组织、腺窝增生组织剥离面组织学检查。比较该组患者手术前及术后12个月IPSS、Qmax、PVR、RE等指标，评估其疗效。结果 42例术后并发膀胱颈挛缩2例，100%出现逆行射精。术前平均IPSS：21.4±3.2；Qmax：（8±2.5）ml/s；PVR：（95±22.4）ml。术后12个月平均IPSS：7.5±1.6；Qmax：（17.2±3.2）ml/s；PVR：（18±4.3）ml。手术前后各组数据相比，差异显著。组织学检查显示：颈口组织以混杂增生的平滑肌细胞、纤维组织、横纹肌组织为主；剥离面以增生的纤维组织为主，夹杂散在的腺体组织。结论 治疗小体积前列腺增生，采用经尿道腔内剜除法联合选择性膀胱颈切除效果确切。

Transurethral Enucleation Resection Combine Selectivity Neck Resection for Treating Small-size Prostate Hyperplasia

Objective To introduce our transurethral way for treating small-size prostate hyperplasia, and summarize the curative effect. Methods 42 prostate hyperplasia patients, all their volum less than 30 millilitre. Transurethral enucleation resection of the prostate; resection 5 to 7 point bladder neck along the enucleation surface; clipping bladder neck annulus fibrosus from 3 to 4 and 8 to 9 point. The ablated bladder neck and enucleation surface tissues were histological examed. The pre- and 12 months post-operation effects were evaluated by international prostate symptom (IPSS), maximum flow rate (Qmax), post-voiding residual urine volume (PVR) and retrograde ejaculation (RE). Results 2 cases were complicated with contracture of the bladder neck in 42 cases, 100% cases complicated with retrograde ejaculation. The pre-operation IPSS, Qmax, PVR, were 21.4±3.2, （8±2.5）ml/s，（95±22.4）ml respectively; were 7.5±1.6，（17.2±3.2）ml/s，（18±4.3）ml 12 months post-operation respectively. Significant statistics difference (p<0.01) were observed between pre- and post- datas. Hstological exam showed that the bladder neck tissues were mixed smooth muscle, fibrous tissue and striated muscle; the enucleation surface were hyperplastic fibrous tissue and sporadic glands almostly. Conclusions For Treating Small-size Prostate Hyperplasia, Transurethral enucleation resection of the prostate combine selectivity resection the bladder neck is a certain way.