经尿道等离子分区剜除联合Nesbit电切术在巨大良性前列腺增生手术中的应用
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摘要
目的:探讨经尿道等离子分区剜除联合Nesbit电切术治疗巨大良性前列腺增生症的手术方法和应用价值。方法:自2015年5月~2017年2月,采用经尿道等离子分区剜除联合Nesbit电切术治疗36例前列腺体积超过100 ml的良性前列腺增生症患者,记录手术时间、术中出血量和住院时间,比较术前与术后1、3、6个月国际前列腺症状评分(IPSS)、生活质量(QOL)评分和最大尿流率(Q_(max))。结果:所有患者均顺利完成手术。手术时间(105.6±23.2)min、出血量(120.3±42.9)ml、无输血病例;无电切综合征(TURS)、无穿孔、无输尿管损伤等并发症发生。术后留置导尿管(3.5±1..2)d;住院时间(9 5±2.3)d。术后1、3、6个月IPSS、QOL、Q_(max)较术前均有明显改善(P<0.05)。4例拔尿管后出现轻度尿失禁,术后3个月均恢复。结论:经尿道等离子分区剜除联合Nesbit电切术治疗巨大良性前列腺增生症,切除腺体彻底,手术安全性高,并发症少,值得临床推广。
Objective: To explore the method and clinical value of transurethral plasmakinetic enucleation of prostate combined with partitioned resection using Nesbit technique in treating benigh prostatic hyperplasia(BPH)with huge volume. Methods: From May 2015 to February 2017, a total of 36 cases of BPH with huge volume greater than 100 mL were treated with transurethral plasmakinetic enucleation of prostate combined with partitioned resection using Nesbit technique at our institution and the clinical data were collected and analyzed. Results: All operations were successfully carried out. Operative time was(105. 6±23. 2)min. Estimated blood loss was(120. 3±42. 9)mL. There were no cases with transfusion, transurethral resection syndrome(TURS) or ureteral injury.Mean catheterization time was(3. 5±1. 2)days and hospital stay was(9. 5±2. 3)days. Patients had significant improved IPSS score, QOL score and Q_(max) one month after surgey(P<0. 05). Four patients, suffering from mild incontinence after catheter removal, were all recovered three months later. Conclusions: Transurethral plasmakinetic enucleation of prostate combined with partitioned resection using Nesbit technique was a safe and efficient surgical method in treating BPH with huge volume.
Objective: To explore the method and clinical value of transurethral plasmakinetic enucleation of prostate combined with partitioned resection using Nesbit technique in treating benigh prostatic hyperplasia(BPH)with huge volume. Methods: From May 2015 to February 2017, a total of 36 cases of BPH with huge volume greater than 100 mL were treated with transurethral plasmakinetic enucleation of prostate combined with partitioned resection using Nesbit technique at our institution and the clinical data were collected and analyzed. Results: All operations were successfully carried out. Operative time was(105. 6±23. 2)min. Estimated blood loss was(120. 3±42. 9)mL. There were no cases with transfusion, transurethral resection syndrome(TURS) or ureteral injury.Mean catheterization time was(3. 5±1. 2)days and hospital stay was(9. 5±2. 3)days. Patients had significant improved IPSS score, QOL score and Q_(max) one month after surgey(P<0. 05). Four patients, suffering from mild incontinence after catheter removal, were all recovered three months later. Conclusions: Transurethral plasmakinetic enucleation of prostate combined with partitioned resection using Nesbit technique was a safe and efficient surgical method in treating BPH with huge volume.
引文
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[12]余闫宏,姜安超,齐书武,等.前列腺剜除术导致尿失禁的力学因素浅析(附2270例报道).中国男科学杂志,2016,30(1):34-37.
[13]李传印,郑少波,刘春晓,等.经尿道逆行腔内剜除双极电切治疗巨大前列腺增生.实用医学杂志,2013,29(13):2174-2177.
[14]Liu C,Zheng S,Li H,et al.Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics.J Urol,2010,184(6):2440-2445.
[15]张浩,司徒杰,李名钊,等.侧人路4步法经尿道前列腺等离子解剖性剜除术治疗大体积前列腺增生.中华腔镜泌尿外科杂志(电子版),2016,10(1):5-7.
[2]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾诊断治疗指南.北京:人民卫生出版社,2014:245-261.
[3]刘春晓.传统经尿道前列腺电切术不应再是前列腺增生腔内治疗的金标准.现代泌尿外科杂志,2012,17(3):298-299.
[4]Zwergel U,Wullich B,Lindenmeir U,et al.Long-term results following transurethral resection of the prostate.Eur Urol,1998,33(5):476-480.
[5]Rassweiler J,Teber D,Kuntz R,et al.Complications of transurethral resection of the prostate(TURP)--incidence,management,and prevention.Eur Urol,2006,50(5):969-979,discussion 980.
[6]张玉辉,夏似龙,倪少滨.经尿道2μm激光前列腺剜除术及前列腺电切术治疗大体积良性前列腺增生的疗效比较.现代泌尿外科杂志,2015,20(4):244-247.
[7]黄敏志,黄裕清,余自强,等.经尿道等离子剜除术治疗巨大良性前列腺增生的疗效观察.现代泌尿生殖肿瘤杂志,2017,9(1):29-32.
[8]李如亮,李春平,杨明辉,等.经尿道等离子双极电切术治疗前列腺增生症(附53例报告).微创泌尿外科杂志,2014,3(1):57-58.
[9]钟林,王禾,陈宝琦.开放性手术、经尿道电汽化切割和组织间激光消融治疗良性前列腺增生的疗效评价.中华泌尿外科杂志,2002,23(3):171-173.
[10]刘春晓.实用经尿道手术学:经尿道前列腺手术.北京:人民卫生出版社,2011:163-212.
[11]杨帝宽,刘春晓.经尿道前列腺腔内剜除术.中华腔镜泌尿外科杂志(电子版),2011,5(6):516-518.
[12]余闫宏,姜安超,齐书武,等.前列腺剜除术导致尿失禁的力学因素浅析(附2270例报道).中国男科学杂志,2016,30(1):34-37.
[13]李传印,郑少波,刘春晓,等.经尿道逆行腔内剜除双极电切治疗巨大前列腺增生.实用医学杂志,2013,29(13):2174-2177.
[14]Liu C,Zheng S,Li H,et al.Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics.J Urol,2010,184(6):2440-2445.
[15]张浩,司徒杰,李名钊,等.侧人路4步法经尿道前列腺等离子解剖性剜除术治疗大体积前列腺增生.中华腔镜泌尿外科杂志(电子版),2016,10(1):5-7.