经尿道等离子前列腺电切术和前列腺剜除术治疗前列腺增生的临床疗效观察
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摘要
目的评价经尿道双极等离子前列腺剜除术与经尿道双极等离子电切术比较治疗前列腺增生(BPH)的疗效和安全性。方法将2015年9月至2018年2月在本院行微创手术治疗前列腺增生患者196例纳入研究对象,其中50例行经尿道双极等离子前列腺剜除术,146例行经尿道双极等离子前列腺电切术,对患者术前、术后随访3个月时的前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量(PVR)等以及术中失血、手术时间、膀胱冲洗时间、尿管留置时间和术后不良反应等临床指标进行统计分析。结果两组术前基本情况一致。术中临床指标显示,剜除组在术中冲洗液的出血量(126.52±32 vs 83.26±28.65)ml、手术时间(82.26±26.2 vs 63.3±18.9)min、膀胱冲洗时间(47±6.2 vs 32±2.3)h、尿管留置时间(6.2±3.1 vs 5.0±1.9)d、术后尿道膀胱刺激征(58 vs 3)例和拔除尿管后再次留置尿管事件(8 vs 0)例方面均优于电切组;术后短暂性尿失禁发生与电切组相近(6 vs 2)例,差异无统计学意义。术后随访3个月的结果显示,两组在IPSS(2.48±1.23 vs 2.10±1.03)、QOL(1.48±0.25 vs 1.45±0.15)、PVR(2.82±2.70 vs 2.78±2.97)和尿道狭窄(3 vs 2)方面差异无统计学意义,但尿路刺激症状发生低于电切组(26 vs 1),差异有统计学意义(P<0.05)。结论经尿道双极等离子前列腺剜除术与经尿道双极等离子前列腺电切术治疗前列腺增生的近期手术疗效相当,且手术安全性更高,是治疗前列腺增生症比较理想的方法,值得临床推广,但其远期疗效仍需大样本长期随访进一步证实。
Objective To evaluate the efficacy and safety of transurethral bipolar plasma prostatectomy and transurethral bipolar plasmatomy for prostate hyperplasia(BPH). Methods Between September 2015 and February 2018 in our hospital minimally invasive surgical treatment of 196 patients with prostatic hyperplasia in the object of study, 50 of whom underwent transurethral bipolar plasma prostate gouge out in addition to surgery,146 underwent transurethral bipolar plasma cutting, prostate of patients with preoperative and postoperative follow-up of 3 months of prostate symptom score(IPSS), quality of life score(QOL), maximum urinary flow rate(Qmax), residual urine volume(PVR) and intraoperative blood loss, operative time, bladder douche time, urine tube indwelling time and postoperative adverse reactions such as clinical indexes were analyzed. Results The two groups had the same preoperative condition. Intraoperative clinical indicators showed, Gouge out in addition to the group in intraoperative rinses the bleeding(126.52±32 vs 83.26±28.65)ml, operation time(82.26±26.2 vs 63.3±18.9)min, bladder douche time(47±6.2 vs 32±2.3)h, urine tube indwelling time(47±6.2 vs 32±2.3) h, postoperative urinary bladder irritation(58 vs 3) cases and pull out again after the urine tube event placing a urinary catheter(8 vs 0) cases are superior to cut electricity group; The incidence of postoperative transient incontinence was similar to that of the electrotomy group(6 vs 2) cases, and the difference was not statistically significant. Postoperative follow-up for 3 months showed no statistically significant differences in IPSS(2.48±1.23 vs 2.10±1.03), QOL(1.48±0.25 vs 1.45±0.15), PVR(2.82±2.70 vs 2.78±2.97) and urethral stricture(3 vs 2), but urinary tract irritation symptoms were lower than those in the electrotomy group(26 vs 1)(P<0.05). Conclusion Transurethral bipolar plasma prostatectomy and transurethral bipolar plasma resection of the prostate in the treatment of benign prostatic hyperplasia is similar to the short-term surgical effect, and the surgical safety is higher, is an ideal method for the treatment of benign prostatic hyperplasia, worthy of clinical promotion, However, long term follow-up results still need further confirmation.
Objective To evaluate the efficacy and safety of transurethral bipolar plasma prostatectomy and transurethral bipolar plasmatomy for prostate hyperplasia(BPH). Methods Between September 2015 and February 2018 in our hospital minimally invasive surgical treatment of 196 patients with prostatic hyperplasia in the object of study, 50 of whom underwent transurethral bipolar plasma prostate gouge out in addition to surgery,146 underwent transurethral bipolar plasma cutting, prostate of patients with preoperative and postoperative follow-up of 3 months of prostate symptom score(IPSS), quality of life score(QOL), maximum urinary flow rate(Qmax), residual urine volume(PVR) and intraoperative blood loss, operative time, bladder douche time, urine tube indwelling time and postoperative adverse reactions such as clinical indexes were analyzed. Results The two groups had the same preoperative condition. Intraoperative clinical indicators showed, Gouge out in addition to the group in intraoperative rinses the bleeding(126.52±32 vs 83.26±28.65)ml, operation time(82.26±26.2 vs 63.3±18.9)min, bladder douche time(47±6.2 vs 32±2.3)h, urine tube indwelling time(47±6.2 vs 32±2.3) h, postoperative urinary bladder irritation(58 vs 3) cases and pull out again after the urine tube event placing a urinary catheter(8 vs 0) cases are superior to cut electricity group; The incidence of postoperative transient incontinence was similar to that of the electrotomy group(6 vs 2) cases, and the difference was not statistically significant. Postoperative follow-up for 3 months showed no statistically significant differences in IPSS(2.48±1.23 vs 2.10±1.03), QOL(1.48±0.25 vs 1.45±0.15), PVR(2.82±2.70 vs 2.78±2.97) and urethral stricture(3 vs 2), but urinary tract irritation symptoms were lower than those in the electrotomy group(26 vs 1)(P<0.05). Conclusion Transurethral bipolar plasma prostatectomy and transurethral bipolar plasma resection of the prostate in the treatment of benign prostatic hyperplasia is similar to the short-term surgical effect, and the surgical safety is higher, is an ideal method for the treatment of benign prostatic hyperplasia, worthy of clinical promotion, However, long term follow-up results still need further confirmation.
引文
[1]黄翼然.泌尿外科手术并发症的预防与处理[M].上海:上海科学技术出版社,2014:265-266.
[2]刘春晓.经尿道前列腺剜除术[J/CD].中华腔镜泌尿外科杂志电子版,2009,3(1):54.
[3]顾方六.现代前列腺病学[M].北京:人民军医出版社.2002:204-207.
[4]房玉和,王金海,李白明,等.经尿道电切镜前列腺剜除术治疗良性前列腺增生近期疗效观察,山东医药,2009,49(36):91-92.
[5]布块孟它,黄祥,沈良伟,等.高海拔地区前列腺增生患者行等离子前列腺汽化电切术与经尿道前列腺电切术的比较[J/CD].中华腔镜泌尿外科杂志电子版,2014,12(8):10-13.
[6] Martis G, Cardi A, Massimo D, et al. Transurethral resection of prostateaechnical progress and clinical experience using the bipolar Gyrus plasmakinetictissue management system[J]. Surg Endosc, 2008,22(9):2078-2083.
[7] Qu L, Wang X, Huang X, et al. The hemostatic properties of transurethral plasmakinetic resection of the prostate:comparison with conventional resectoscope in an ex vivo study[J]. Urol Int, 2008,80(3):292-295.
[8]唐青,庞俊,吴奇.经尿道前列腺剜除术治疗大体积前列腺增生[J/CD].中华腔镜泌尿外科杂志电子版,2015,9(4):274-277.
[9]王荣,陈伟军,史文华,等.经尿道等离子双极和经膀胱前列腺摘除术治疗大体积良性前列腺增生的临床疗效比较[J].中国男科学杂志,2014,28(6):33-37.
[10]林宁峰,刘昌明,李国敏.经尿道等离子前列腺电切术和剜除术治疗前列腺增生的临床疗效比较[J].当代医学,2011,17(27):58-59.
[11]刘春晓,徐阿白,邹勇.经尿道前列腺解剖性剜除术[J/CD].现代泌尿外科杂志,2014,8(19):495-498.
[12]那彦群.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社.2014:259-260.
[2]刘春晓.经尿道前列腺剜除术[J/CD].中华腔镜泌尿外科杂志电子版,2009,3(1):54.
[3]顾方六.现代前列腺病学[M].北京:人民军医出版社.2002:204-207.
[4]房玉和,王金海,李白明,等.经尿道电切镜前列腺剜除术治疗良性前列腺增生近期疗效观察,山东医药,2009,49(36):91-92.
[5]布块孟它,黄祥,沈良伟,等.高海拔地区前列腺增生患者行等离子前列腺汽化电切术与经尿道前列腺电切术的比较[J/CD].中华腔镜泌尿外科杂志电子版,2014,12(8):10-13.
[6] Martis G, Cardi A, Massimo D, et al. Transurethral resection of prostateaechnical progress and clinical experience using the bipolar Gyrus plasmakinetictissue management system[J]. Surg Endosc, 2008,22(9):2078-2083.
[7] Qu L, Wang X, Huang X, et al. The hemostatic properties of transurethral plasmakinetic resection of the prostate:comparison with conventional resectoscope in an ex vivo study[J]. Urol Int, 2008,80(3):292-295.
[8]唐青,庞俊,吴奇.经尿道前列腺剜除术治疗大体积前列腺增生[J/CD].中华腔镜泌尿外科杂志电子版,2015,9(4):274-277.
[9]王荣,陈伟军,史文华,等.经尿道等离子双极和经膀胱前列腺摘除术治疗大体积良性前列腺增生的临床疗效比较[J].中国男科学杂志,2014,28(6):33-37.
[10]林宁峰,刘昌明,李国敏.经尿道等离子前列腺电切术和剜除术治疗前列腺增生的临床疗效比较[J].当代医学,2011,17(27):58-59.
[11]刘春晓,徐阿白,邹勇.经尿道前列腺解剖性剜除术[J/CD].现代泌尿外科杂志,2014,8(19):495-498.
[12]那彦群.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社.2014:259-260.