经尿道前列腺剜除术治疗良性前列腺增生

目的 评价经尿道前列腺剜除( transurethral enucleation of prostate,TUEP)术治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的安全性和临床疗效. 方法 2005年1月～2012年1月行TUEP治疗BPH患者840例,其中行TUEP+电切术828例,TUEP+粉碎术5例,TUEP+小切口腺体取出术7例.使用单极电切328例,使用双极电切512例.对术中出血量、手术时间、术后并发症进行观察分析. 结果 本组840例患者手术顺利,术中无输血,无前列腺电切综合征发生,术后5～7d拔除尿管.840例术后随访3 ～18个月,平均(6.5±1.5)个月.术后3个月IPSS评分、残余尿量、最大尿流率及QOL评分分别为(5.4±3.5)分、(4.3±1.7)ml、(18.8±2.1)ml/s及(1.6±0.7)分,明显优于术前(22.5±7.3)分、(90.4 ±36.6)ml、(8.2±3.2) ml/s和(4.5±0.6)分,差异有统计学意义(P＜0.01).术后尿道狭窄8例,膀胱颈挛缩2例,压力性尿失禁20例.将行TUERP的828例患者按切除前列腺组织的重量分为三组,发现手术时间、出血量及术后压力性尿失禁率随着前列腺体积和重量的增加而相应增加,与前列腺体积和重量呈明显正相关(P＜0.05).20例压力性尿失禁患者经盆底肌功能锻炼,3个月左右恢复完全控尿,未发现永久性尿失禁.无术后排尿困难、大出血及永久性尿失禁等并发症发生.结论 TUEP是经尿道前列腺切除术的创新性进展,总体优势明显,值得临床应用与推广.

Transurethral Enucleation of Prostate for Benign Prostatic Hyperplasia:with A Reportof 840 Cases

Objective To evaluate the safety and clinical effect of transurethral enucleation of prostate(TUEP)in treatment of benign prostatic hyperplasia(BPH).Methods 840 BPH cases admitted from January 2005 to January 2012 were treated by TUEP,including 828 cases of transurethral enucleation and resection of prostate(TUERP),5 of transurethral enucleation and morcellation of prostate(TUEMP) and 7 of TUEP plus gland removal via small incision.Monopolar electrome was applied in 328 cases and bipolar electrome was applied in 512 cases.The intraoperative blood loss,operative duration and postoperative complications were analyzed.Results All 840 cases were performed the surgery successfully without blood transfusion and transurethral resection syndrome(TURS) during the operation.The urinary catheter was extracted 5 to 7 days after the operation.All cases were followed up for 3 to 18 months.The IPSS score,residual urine volume,maximum flow rate and QOL score was 5.4±3.5,4.3±1.7 ml,18.8±2.1 ml/s and 1.6±0.7 respectively 3 months after the operation,and which was better than 22.5±7.3,90.4±36.6 ml,8.2±3.2 ml/s and 4.5±0.6 respectively before the operation(P<0.01).Postoperative urethral stricture was found in 8 cases,bladder neck contracture in 2 cases and stress urinary incontinence in 20 cases.The operative duration,blood loss volume and stress urinary incontinence rate was increased along with increment of prostatic volume and weight,and showed an obviously positive correlation(P<0.05).No postoperative dysuria,hemorrhea and permanent urinary incontinence occured.Conclusion TUEP is an innovative progress to TURP with obviously overall advantages,and is worthy of being applied and popularized.