经尿道等离子前列腺剜除术282例

目的探讨经尿道等离子前列腺腔内剜除术治疗良性前列腺增生症（Benign prostatic hyperplasia,BPH）的临床应用价值。方法应用前列腺等离子双极气化电切镜的外鞘及电切袢,在增生的腺体与外科包膜间剥离,边剥离边止血,将整个增生的腺体从腺窝里剜除后切碎并吸出。结果前列腺包膜穿孔2例,膀胱前列腺连接部穿孔行腹腔引流2例;轻度尿失禁42例,一周内可恢复,压力性尿失禁4例,均在6个月内恢复,无永久性尿失禁发生;无输血、TUR综合征及再次手术病例。切除腺体组织25～125g,平均50g,大于60g者66例,手术时间45～150min,平均70min,术中出血50～200ml。随访3个月～2年,Qmax均恢复正常,IPSS评分≤7分。结论前列腺腔内剜除术暂时性尿失禁发生率较高,但该术式出血少,切除腺体组织彻底,症状改善明显,安全性高,尤其适用于大体积前列腺。

Transurethral plasmakinetic resection of the prostate: a report of 282 cases

Objective To explore the clinical application value of plasmakinetic enucleation of the prostate(PKEP) with Gyrus Plasma-Kinatic System and endoscope system(PKS) in the treatment of benign prostatic hyperplasia(BPH).Methods Gyrus Plasma-Kinatic System and endoscope system was used.The prostatic adenoma was enucleated firstly in the surgical capsule.Staunching had been performed when BPH enucleating.The total prostatic adenoma had been enucleated from the surgical capsule,and cut up then exsuctioned.282 cases were treated with PKEP between January 2009 and December 2010,and the data in these cases had been observed and analyzed.The indexes such as IPSS,QOL,RUV were monitored and analyzed at the preoperative and postoperative.Results The rupture of the prostatic capsule had happened in two cases.The perforation of the bladder prostate junction had occurred in two cases,and the two cases had cathetered from abdomen cavity.42 patientes(14.5%) had developed urinary incontinence in a degree,and they had recovered in a week.4 patientes(1.4%) had developed tension urinary incontinence,and they had recovered in six months.No patient developed permanence urinary incontinence.No case had needed blood transfusion.No TUR syndrome had happened.And no re-operation had performed in this series.The resected prostate tissues weighed 25 to 125 g(mean,50 g).The resected prostate tissues over-weighed 60 g in 66 cases.The operation time had ranged from 45 to 150 min(mean,70 min),and the blood loss was 50-200 ml.All the cases had been followed up from 3 months to 2 years.The maximum flow rate(Qmax) had recovered normally in this series,and the International prostate symptom score(IPSS) were no more than seven.Conclusion The temporality urinary incontinence occur mostly in the cases suffered from PKEP for BPH.But the PKEP is fit for the treatment of huge BPH,benefited from little blood loss,total prostate tissues resection,effective relief and well security.