经尿道前列腺等离子双极电切术治疗大体积良性前列腺增生的临床研究
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摘要
目的探究经尿道前列腺等离子双极电切术(transurethral plasmakinetic resection of prostate,PKRP)治疗大体积良性前列腺增生(benign prostatic hyperplasia,BPH)的临床疗效及其对性功能的影响。方法选择2015年1月至2016年7月临海市第一人民医院诊治的80例大体积(>80mL)BPH患者为研究对象,按照手术方式不同将其分为PKPR组(n=40)和经膀胱前列腺摘除术(TVP)组(n=40)。比较两组患者手术时间、术中出血量、血钠下降、血红蛋白下降、膀胱冲洗时间、留置导管时间和住院时间等手术相关指标差异;术后随访1年,比较两组患者术后临床指标[国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、膀胱剩余尿量(PVR)]变化和术后并发症发生率,并评价手术对两组患者性功能(勃起障碍、精液量减少、逆行射精)的影响。结果 PKPR组患者手术时间、膀胱冲洗时间、留置导管时间和住院时间显著短于TVP组患者,术中出血量、血钠下降和血红蛋白下降值显著少于TVP组患者,术后1年IPSS、QOL、QOL、Qmax、PVR等临床指标改善情况显著优于TVP组患者,并发症发生率(7.5%,3/40)显著低于TVP组患者(32.5%,13/40),其差异均具有统计学意义(均P<0.05);PKPR组患者术后共出现2例(5.0%)勃起障碍、1例(2.5%)精液量减少和7例(17.5%)逆行射精,TVP组患者术后共出现8例(20.0%)勃起障碍、6例(15.0%)精液量减少和16例(40.0%)逆行射精,两组差异均具有统计学意义(均P<0.05)。结论 PKRP治疗大体积BPH手术时间短、术中出血少、术后恢复快,是一种安全有效的治疗方式,且对患者术后性功能的影响较小。
Objective To explore the clinical efficacy of transurethral plasmakinetic resection of prostate(PKRP) for large volume benign prostatic hyperplasia(BPH) and its effects on the sexual function. Methods 80 patients with large volume(>80 mL) BPH treated in Linhai First People′s Hospital from January 2015 to July 2016 were divided into the PKPR group(n=40) and the transvesical prostatectomy(TVP) group(n=40) according to different surgical methods. The operative time, intraoperative blood loss, the decrease of blood sodium and hemoglobin, the bladder irrigation time, the indwelling catheter time and the hospital stays and other surgical related index were compared between the two groups. All the patients were followed up for a year. The postoperative clinical indexes(IPSS, QOL, QOL, Qmax, PVR) and the incidence rate of postoperative complications were compared between the two groups, and the effects of surgery on the sexual function(erectile dysfunction, semen volume reduction and retrograde ejaculation) were evaluated in the two groups. Results The operative time, bladder irrigation time, indwelling catheter time and hospital stay in the PKPR group were significantly shorter than those in the TVP group, and the intraoperative blood loss, the decrease values of blood sodium and hemoglobin were significantly less than those in the TVP group, and the improvement of IPSS, QOL, Qmax, PVR and other clinical indexes at a year after operation was significantly better than that in the TVP group, and the complication rate was significantly lower than that in the TVP group [(7.5%, 3/4) vs(32.5%, 13/40)], all with statistically significant differences(P<0.05). There were 2 cases(5.0%) of erectile dysfunction, a case(2.5%) of semen volume reduction and 7 cases(17.5%) of retrograde ejaculation in the PKPR group after operation, and there were 8 cases(20.0%), 6 cases(15.0%) and 16 cases(40.0%) respectively in the TVP group after operation, all with statistically significant differences(all P<0.05). Conclusions PKRP treatment is a safe and effective way to treat large volume BPH with short operative time, less intraoperative blood loss and quick postoperative recovery and little impact on postoperative sexual function.
Objective To explore the clinical efficacy of transurethral plasmakinetic resection of prostate(PKRP) for large volume benign prostatic hyperplasia(BPH) and its effects on the sexual function. Methods 80 patients with large volume(>80 mL) BPH treated in Linhai First People′s Hospital from January 2015 to July 2016 were divided into the PKPR group(n=40) and the transvesical prostatectomy(TVP) group(n=40) according to different surgical methods. The operative time, intraoperative blood loss, the decrease of blood sodium and hemoglobin, the bladder irrigation time, the indwelling catheter time and the hospital stays and other surgical related index were compared between the two groups. All the patients were followed up for a year. The postoperative clinical indexes(IPSS, QOL, QOL, Qmax, PVR) and the incidence rate of postoperative complications were compared between the two groups, and the effects of surgery on the sexual function(erectile dysfunction, semen volume reduction and retrograde ejaculation) were evaluated in the two groups. Results The operative time, bladder irrigation time, indwelling catheter time and hospital stay in the PKPR group were significantly shorter than those in the TVP group, and the intraoperative blood loss, the decrease values of blood sodium and hemoglobin were significantly less than those in the TVP group, and the improvement of IPSS, QOL, Qmax, PVR and other clinical indexes at a year after operation was significantly better than that in the TVP group, and the complication rate was significantly lower than that in the TVP group [(7.5%, 3/4) vs(32.5%, 13/40)], all with statistically significant differences(P<0.05). There were 2 cases(5.0%) of erectile dysfunction, a case(2.5%) of semen volume reduction and 7 cases(17.5%) of retrograde ejaculation in the PKPR group after operation, and there were 8 cases(20.0%), 6 cases(15.0%) and 16 cases(40.0%) respectively in the TVP group after operation, all with statistically significant differences(all P<0.05). Conclusions PKRP treatment is a safe and effective way to treat large volume BPH with short operative time, less intraoperative blood loss and quick postoperative recovery and little impact on postoperative sexual function.
引文
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[2] 郭亚雄,刘安.经尿道前列腺电切术与开放性手术对良性前列腺增生患者性功能的影响分析[J].中国性科学,2016,25(6):15-18.
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[5] 甘露,曾静,黄桂晓,等.经尿道前列腺等离子双极电切术与耻骨上经膀胱前列腺切除术治疗良性前列腺增生的疗效和安全性比较[J].医学综述,2014,20(5):959-960.
[6] 曾杨军,胡万里,程龙,等.经尿道前列腺等离子双极电切术和电切术治疗良性前列腺增生对性功能影响的Meta分析[J].临床外科杂志,2016,24(5):386-389.
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[8] 王毓斌,邵晋凯,李晓东,等.二微米激光前列腺汽化剜除术与经尿道双极等离子前列腺切除术治疗大体积良性前列腺增生效果比较[J].中国医药,2016,11(12):1819-1822.
[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] 蒋树荣.经尿道前列腺等离子双极电切术治疗良性前列腺增生的疗效观察及安全性评估[J].医学综述,2014,20(19):3610-3612.
[11] Bilhim T,Bagla S,Sapoval M,et al.Prostatic arterial embolization versus transurethral resection of the prostate for benign prostatic hyperplasia[J].Radiology,2015,276(1):310-311.
[12] 盛明雄,万玲玲,刘昌明.经尿道选择性绿激光汽化术与经尿道等离子电切术治疗大体积前列腺增生的比较[J].实用医学杂志,2016,32(23):3890-3893.
[13] 王宁华,苏元华,董锐,等.经尿道等离子双极电切术与开放式前列腺切除术对前列腺增生患者性功能的影响[J].中国性科学,2017,26(7):8-11.
[14] 邓辉,马春清,祝存海.经尿道双极等离子电切术对良性前列腺增生患者尿道功能与性功能的影响[J].中国性科学,2016,25(4):18-21.
[15] Gao YA,Huang Y,Zhang R,et al.Benign prostatic hyperplasia:Prostatic arterial embolization versus transurethral resection of the prostate-A prospective,randomized,and controlled clinical trial[J].Radiology,2013,270(3):920-928.
[2] 郭亚雄,刘安.经尿道前列腺电切术与开放性手术对良性前列腺增生患者性功能的影响分析[J].中国性科学,2016,25(6):15-18.
[3] 郑鸣,蒋庆详,李树人,等.负压吸引联合经尿道前列腺等离子双极电切术对大体积前列腺增生手术的治疗价值[J].中国内镜杂志,2014,20(11):1228-1230.
[4] 熊文清,万建,付明.经尿道前列腺等离子双极电切术治疗大体积良性前列腺增生症疗效观察[J].临床外科杂志,2015,23(10):789-791.
[5] 甘露,曾静,黄桂晓,等.经尿道前列腺等离子双极电切术与耻骨上经膀胱前列腺切除术治疗良性前列腺增生的疗效和安全性比较[J].医学综述,2014,20(5):959-960.
[6] 曾杨军,胡万里,程龙,等.经尿道前列腺等离子双极电切术和电切术治疗良性前列腺增生对性功能影响的Meta分析[J].临床外科杂志,2016,24(5):386-389.
[7] 周亚,林长丰,李永,等.经尿道前列腺等离子双极电切治疗良性前列腺增生症[J].河北医药,2016,38(10):1533-1534.
[8] 王毓斌,邵晋凯,李晓东,等.二微米激光前列腺汽化剜除术与经尿道双极等离子前列腺切除术治疗大体积良性前列腺增生效果比较[J].中国医药,2016,11(12):1819-1822.
[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] 蒋树荣.经尿道前列腺等离子双极电切术治疗良性前列腺增生的疗效观察及安全性评估[J].医学综述,2014,20(19):3610-3612.
[11] Bilhim T,Bagla S,Sapoval M,et al.Prostatic arterial embolization versus transurethral resection of the prostate for benign prostatic hyperplasia[J].Radiology,2015,276(1):310-311.
[12] 盛明雄,万玲玲,刘昌明.经尿道选择性绿激光汽化术与经尿道等离子电切术治疗大体积前列腺增生的比较[J].实用医学杂志,2016,32(23):3890-3893.
[13] 王宁华,苏元华,董锐,等.经尿道等离子双极电切术与开放式前列腺切除术对前列腺增生患者性功能的影响[J].中国性科学,2017,26(7):8-11.
[14] 邓辉,马春清,祝存海.经尿道双极等离子电切术对良性前列腺增生患者尿道功能与性功能的影响[J].中国性科学,2016,25(4):18-21.
[15] Gao YA,Huang Y,Zhang R,et al.Benign prostatic hyperplasia:Prostatic arterial embolization versus transurethral resection of the prostate-A prospective,randomized,and controlled clinical trial[J].Radiology,2013,270(3):920-928.