经尿道双极等离子前列腺切除术治疗良性前列腺增生症的疗效及对尿道和性功能的影响
|
摘要
目的以经尿道前列腺切除术(TURP)为对照,探讨经尿道双极等离子电切术(PKRP)治疗良性前列腺增生(BPH)的安全性和有效性。方法选择2014年1月-2017年12月在该院治疗的98例BPH患者作为研究对象,采用随机数表法将患者分为观察组和对照组,每组49例。观察组采用PKRP治疗,对照组采用TURP治疗。术后随访3个月,观察以下指标:①一般指标:手术时间、术中出血量、置管时间、腺体组织重量和住院时间;②尿道功能:最大尿流率、残余尿量、国际前列腺症状评分(IPSS)和生活质量评分(QOL);③血红蛋白和红细胞压积;④术后并发症;⑤性功能:采用勃起功能指数(IIEF-5)进行评价。结果①观察组手术时间和患者住院时间明显较对照组短,差异均有统计学意义(P <0.05),两组留置尿管时间和腺体组织重量的比较,差异均无统计学意义(P>0.05);②术后两组患者最大尿流率、残余尿量、IPSS评分和QOL评分均明显改善,且观察组优于对照组,差异均有统计学意义(P <0.05);③两组血红蛋白和红细胞压积均明显下降,且观察组低于对照组,差异有统计学意义(P <0.05);④术后两组IIEF-5评分均明显升高,且观察组高于对照组,差异有统计学意义(P <0.05);⑤观察组不良反应的总发生率明显低于对照组,差异有统计学意义(P <0.05)。结论 PRKP治疗BPH的效果较好,可以改善患者尿道功能和性功能,疗效优于TURP,并且并发症较少。
Objective To investigate the safety and efficacy of transurethral plasma kinetic resection of prostate(PKRP) for benign prostatic hyperplasia, to take transurethral resection of the prostate(TURP) as control. Methods 98 patients with benign prostatic hyperplasia from January 2014 to December 2017 were included.The patients were divided into observation group and control group randomly. The observation group was treated with PKRP, while the control group was treated with TURP. All the patients were followed up for 3 months after surgery. Observation index: Operation time, intraoperative bleeding, tube time, gland tissue weight and hospitalization time; Urethral function: maximum urinary flow rate, residual urine volume, international prostatic symptom score(IPSS) and quality of life scale(QOL); hemoglobin and hematocrit; postoperative complications; sexual function:erectile function index(IIEF-5) was used for evaluation. Results The operative time and hospitalization time in the observation group were significantly lower than those in the control group(P < 0.05). There was no significant difference between the two groups in the time of indwelling catheter and the weight of gland tissue(P > 0.05);After operation, the maximum urine flow rate, the residual urine volume, the IPSS score and the QOL score were significantly improved in the two groups, and the observation group was better than the control group(P < 0.05); Two groups of hemoglobin and hematocrit decreased significantly, and the observation group was lower than the control group(P < 0.05); The IIEF-5 scores of the two groups increased significantly after operation, and the observation group was higher than the control group(P < 0.05); The total incidence of adverse reactions in the observation group was significantly lower than the control group(P < 0.05). Conclusion PRKP is effective in treating benign prostatic hyperplasia. It can improve the urethral function and sexual function of patients. The curative effect is better than TURP and there are fewer complications.
Objective To investigate the safety and efficacy of transurethral plasma kinetic resection of prostate(PKRP) for benign prostatic hyperplasia, to take transurethral resection of the prostate(TURP) as control. Methods 98 patients with benign prostatic hyperplasia from January 2014 to December 2017 were included.The patients were divided into observation group and control group randomly. The observation group was treated with PKRP, while the control group was treated with TURP. All the patients were followed up for 3 months after surgery. Observation index: Operation time, intraoperative bleeding, tube time, gland tissue weight and hospitalization time; Urethral function: maximum urinary flow rate, residual urine volume, international prostatic symptom score(IPSS) and quality of life scale(QOL); hemoglobin and hematocrit; postoperative complications; sexual function:erectile function index(IIEF-5) was used for evaluation. Results The operative time and hospitalization time in the observation group were significantly lower than those in the control group(P < 0.05). There was no significant difference between the two groups in the time of indwelling catheter and the weight of gland tissue(P > 0.05);After operation, the maximum urine flow rate, the residual urine volume, the IPSS score and the QOL score were significantly improved in the two groups, and the observation group was better than the control group(P < 0.05); Two groups of hemoglobin and hematocrit decreased significantly, and the observation group was lower than the control group(P < 0.05); The IIEF-5 scores of the two groups increased significantly after operation, and the observation group was higher than the control group(P < 0.05); The total incidence of adverse reactions in the observation group was significantly lower than the control group(P < 0.05). Conclusion PRKP is effective in treating benign prostatic hyperplasia. It can improve the urethral function and sexual function of patients. The curative effect is better than TURP and there are fewer complications.
引文
[1]郭应禄,程文,李宏军.良性前列腺增生的病因和诊治[J].中华老年医学杂志,2006,25(4):317-319.[1]GUO Y L,CHENG W,LI H J.Etiology,diagnosis and treatment of benign prostatic hyperplasia[J].Chinese Journal of Geriatrics,2006,25(4):317-319.Chinese
[2]GUPTA N K,GANGE S N,MCVARY K T.New and emerging technologies in treatment of lower urinary tract symptoms from benign prostatic hyperplasia[J].Sex Med Rev,2018,33(8):1-9.
[3]张晓波,陈明泉,陈雄,等.激光汽化术与前列腺电切术治疗良性前列腺增生疗效的Meta分析[J].中国内镜杂志,2017,23(7):16-21.[3]ZHANG X B,CHEN M Q,CHEN X,et al.Diode laser of prostate versus transurethral resection of prostate in treating benign prostatic hyperplasia:a Meta-analysis[J].China Journal of Endoscopy,2017,23(7):16-21.Chinese
[4]WANG G C,BIAN C D,ZHOU T T,et al.Urethral ultrasonography:a novel diagnostic tool for dysuria following bipolar transurethral plasma kinetic prostatectomy[J].Technol Health Care,2016,24(2):487-492.
[5]ZHAO Z,ZENG G,ZHONG W,et al.A prospective,randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia:three-year follow-up results[J].European Urology,2010,58(5):752-758.
[6]KARAMAN M I,KAYA C,OZTURK M,et al.Comparison of transurethral vaporization using plasmakinetic energy and transurethral resection of prostate:1-year follow-up[J].J Endourol,2005,19(6):734-737.
[7]PENG B,HUANG J,WANG G,et al.Transurethral enucleation of prostate with button electrode plasmakinetic vaporization for the treatment of benign prostatic hyperplasia[J].Scientific Reports,2016,6:39583.
[8]YANG Z,LIU T,WANG X.Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up[J].Lasers in Medical Science,2016,31(9):1797-1802.
[9]UNNIKRISHNAN R,ALMASSI N,FAREED K.Benign prostatic hyperplasia:evaluation and medical management in primary care[J].Cleve Clin J Med,2017,84(1):53-64.
[10]CIMINO S,VOCE S,PALMIERI F,et al.Transurethral resection of the prostate(TURP)vs GreenLight photoselective vaporization of benign prostatic hyperplasia:analysis of BPH6 outcomes after1 year of follow-up[J].Int J Impot Res,2017,29(6):240-243.
[11]赵军,张宁,胡岚亭,等.高龄高危患者经尿道前列腺气化电切术疗效分析[J].中国内镜杂志,2012,18(7):734-737.[11]ZHAO J,ZHANG N,HU L T,et al.The efficacy of transurethral vaporization of the prostate in advanced age and high-risk patients with benign prostatic hyperplasia[J].China Journal of Endoscopy,2012,18(7):734-737.Chinese
[12]PENG M,LI L,WANG Y.Photoselective vaporization of the prostate vs plasmakinetic resection of the prostate:a randomized prospective trial with 12-month follow-up in mainland China[J].Urology,2016,87:161-165.
[13]FALSAPERLA M,CINDOLO L,SAITA A,et al.Transurethral resection of prostate:technical progress by bipolar Gyrus plasmakinetic tissue management system[J].Minerva Urol Nefrol,2007,59(2):125-129.
[14]GU M,CHEN Y B,LIU C,et al.Comparison of holmium laser enucleation and plasmakinetic resection of prostate:a randomized trial with 72-month follow-up[J].J Endourol,2018,32(2):139-143.
[15]XIE T,LAI P,LUO M,et al.The effectiveness and safety of transurethral(bipolar)plasmakinetic resection of prostate combined with thulium laser for large benign prostatic hyperplasia(>80 ml)[J].Urol J,2016,13(6):2889-2892.
[16]D’ANCONA F C,FRANCISCA E A,WITJESWP,et al.Transurethral resection of the prostate vs high‐energy thermotherapy of the prostate in patients with benign prostatic hyperplasia:long‐term results[J].Br J Urol,2015,81(2):259-264.
[17]WOO M J,HA Y S,LEE J N,et al.Comparison of surgical outcomes between holmium laser enucleation and transurethral resection of the prostate in patients with detrusor underactivity[J].International Neurourology Journal,2017,21(1):46-52.
[18]GUO R,YU W,ZHANG K,et al.Impact of changing trends in medical therapy on transurethral resection of the prostate:two decades of change in China[J].Urology,2016,92:80-86.
[19]LIU Z,LI Y W,WU W R,et al.Long-term clinical efficacy and safety profile of transurethral resection of prostate versus plasmakinetic resection of the prostate for benign prostatic hyperplasia[J].Urology,2017,103:198-203.
[20]WANG S J,MU XN,CHEN J,et al.Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia[J].Asian Journal of Andrology,2017,19(1):15-19.
[2]GUPTA N K,GANGE S N,MCVARY K T.New and emerging technologies in treatment of lower urinary tract symptoms from benign prostatic hyperplasia[J].Sex Med Rev,2018,33(8):1-9.
[3]张晓波,陈明泉,陈雄,等.激光汽化术与前列腺电切术治疗良性前列腺增生疗效的Meta分析[J].中国内镜杂志,2017,23(7):16-21.[3]ZHANG X B,CHEN M Q,CHEN X,et al.Diode laser of prostate versus transurethral resection of prostate in treating benign prostatic hyperplasia:a Meta-analysis[J].China Journal of Endoscopy,2017,23(7):16-21.Chinese
[4]WANG G C,BIAN C D,ZHOU T T,et al.Urethral ultrasonography:a novel diagnostic tool for dysuria following bipolar transurethral plasma kinetic prostatectomy[J].Technol Health Care,2016,24(2):487-492.
[5]ZHAO Z,ZENG G,ZHONG W,et al.A prospective,randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia:three-year follow-up results[J].European Urology,2010,58(5):752-758.
[6]KARAMAN M I,KAYA C,OZTURK M,et al.Comparison of transurethral vaporization using plasmakinetic energy and transurethral resection of prostate:1-year follow-up[J].J Endourol,2005,19(6):734-737.
[7]PENG B,HUANG J,WANG G,et al.Transurethral enucleation of prostate with button electrode plasmakinetic vaporization for the treatment of benign prostatic hyperplasia[J].Scientific Reports,2016,6:39583.
[8]YANG Z,LIU T,WANG X.Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up[J].Lasers in Medical Science,2016,31(9):1797-1802.
[9]UNNIKRISHNAN R,ALMASSI N,FAREED K.Benign prostatic hyperplasia:evaluation and medical management in primary care[J].Cleve Clin J Med,2017,84(1):53-64.
[10]CIMINO S,VOCE S,PALMIERI F,et al.Transurethral resection of the prostate(TURP)vs GreenLight photoselective vaporization of benign prostatic hyperplasia:analysis of BPH6 outcomes after1 year of follow-up[J].Int J Impot Res,2017,29(6):240-243.
[11]赵军,张宁,胡岚亭,等.高龄高危患者经尿道前列腺气化电切术疗效分析[J].中国内镜杂志,2012,18(7):734-737.[11]ZHAO J,ZHANG N,HU L T,et al.The efficacy of transurethral vaporization of the prostate in advanced age and high-risk patients with benign prostatic hyperplasia[J].China Journal of Endoscopy,2012,18(7):734-737.Chinese
[12]PENG M,LI L,WANG Y.Photoselective vaporization of the prostate vs plasmakinetic resection of the prostate:a randomized prospective trial with 12-month follow-up in mainland China[J].Urology,2016,87:161-165.
[13]FALSAPERLA M,CINDOLO L,SAITA A,et al.Transurethral resection of prostate:technical progress by bipolar Gyrus plasmakinetic tissue management system[J].Minerva Urol Nefrol,2007,59(2):125-129.
[14]GU M,CHEN Y B,LIU C,et al.Comparison of holmium laser enucleation and plasmakinetic resection of prostate:a randomized trial with 72-month follow-up[J].J Endourol,2018,32(2):139-143.
[15]XIE T,LAI P,LUO M,et al.The effectiveness and safety of transurethral(bipolar)plasmakinetic resection of prostate combined with thulium laser for large benign prostatic hyperplasia(>80 ml)[J].Urol J,2016,13(6):2889-2892.
[16]D’ANCONA F C,FRANCISCA E A,WITJESWP,et al.Transurethral resection of the prostate vs high‐energy thermotherapy of the prostate in patients with benign prostatic hyperplasia:long‐term results[J].Br J Urol,2015,81(2):259-264.
[17]WOO M J,HA Y S,LEE J N,et al.Comparison of surgical outcomes between holmium laser enucleation and transurethral resection of the prostate in patients with detrusor underactivity[J].International Neurourology Journal,2017,21(1):46-52.
[18]GUO R,YU W,ZHANG K,et al.Impact of changing trends in medical therapy on transurethral resection of the prostate:two decades of change in China[J].Urology,2016,92:80-86.
[19]LIU Z,LI Y W,WU W R,et al.Long-term clinical efficacy and safety profile of transurethral resection of prostate versus plasmakinetic resection of the prostate for benign prostatic hyperplasia[J].Urology,2017,103:198-203.
[20]WANG S J,MU XN,CHEN J,et al.Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia[J].Asian Journal of Andrology,2017,19(1):15-19.