经尿道前列腺剜除术中保留12点处尿道黏膜对术后控尿的影响
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摘要
目的:研究TUERP术中保留12点处尿道黏膜对患者术后控尿的影响。方法:2009年12月~2016年1月收治的BPH患者,196例采用标准TUERP,158例采用保留12点处尿道黏膜的TUERP,测定Qmax、PVR,问卷IPSS。术后拔除导尿管后第24h、术后每周分别行尿垫试验,记录尿失禁发生率。于术后第3、6个月时间点随访并记录Qmax、PVR、IPSS等随访指标数据。结果:两组术后Qmax明显提高,PVR明显减少,IPSS评分明显下降(P<0.01)。术后3、6个月组间对比Qmax、PVR、IPSS评分差异无统计学意义(P>0.05)。两组患者术后尿失禁发生情况为拔除尿管后24h非尿道黏膜保留组28例(14.28%),保留12点处尿道黏膜组14例(8.86%)。拔除尿管后1周时非尿道黏膜保留组21例(10.71%),保留12点处尿道黏膜组6例(3.79%),拔除尿管后2周时非尿道黏膜保留组3例(1.53%),保留12点处尿道黏膜组0例,经分析差异有统计学意义(P<0.01)。结论:保留12点处尿道黏膜的前列腺剜除术可以明显改善患者下尿路梗阻症状,同时可以提高患者术后短期尿控能力。
Objective:To evaluate the therapeutic effect of 12 o'clock position urethral mucosa preservation in transurethral enucleation of the prostate for treatment of patients with benign prostate hyperplasia.Methods:354 patients with benign prostate hyperplasia underwent transurethral enucleation of the prostate.196 patients were given complete enucleation of the prostate and urethral mucosa,and 158 patients were subjected to preservation of12 o'clock position urethral mucosa and anterior fibromuscular stroma during the operation.The patients were followed up for 6 months to evaluate the peak flow rate,post-void residual urine volume,and International Prostate Symptom Score before and after operation,respectively.Incontinence rate was evaluated weekly from 24 hto 6 months after surgery.Results:The symptom of lower urinary tract obstruction was improved obviously after surgery in both groups.There were no significant differences in the peak flow rate,post-void residual urine volume,and International Prostate Symptom Score between two groups during the follow-up period.The incontinence rate was lower in patients with preservation of 12 o'clock position urethral mucosa during the operation than in those undergoing complete enucleation of the prostate and urethral mucosa.Conclusions:Preservation of 12 o'clock position urethral mucosa in transurethral enucleation of the prostate can alleviate the low tract obstruction symptom and reduce incontinence rate in patients with benign prostate hyperplasia.
Objective:To evaluate the therapeutic effect of 12 o'clock position urethral mucosa preservation in transurethral enucleation of the prostate for treatment of patients with benign prostate hyperplasia.Methods:354 patients with benign prostate hyperplasia underwent transurethral enucleation of the prostate.196 patients were given complete enucleation of the prostate and urethral mucosa,and 158 patients were subjected to preservation of12 o'clock position urethral mucosa and anterior fibromuscular stroma during the operation.The patients were followed up for 6 months to evaluate the peak flow rate,post-void residual urine volume,and International Prostate Symptom Score before and after operation,respectively.Incontinence rate was evaluated weekly from 24 hto 6 months after surgery.Results:The symptom of lower urinary tract obstruction was improved obviously after surgery in both groups.There were no significant differences in the peak flow rate,post-void residual urine volume,and International Prostate Symptom Score between two groups during the follow-up period.The incontinence rate was lower in patients with preservation of 12 o'clock position urethral mucosa during the operation than in those undergoing complete enucleation of the prostate and urethral mucosa.Conclusions:Preservation of 12 o'clock position urethral mucosa in transurethral enucleation of the prostate can alleviate the low tract obstruction symptom and reduce incontinence rate in patients with benign prostate hyperplasia.
引文
[1]刘俊峰,刘春晓,谭朝晖,等.经尿道双极等离子前列腺剜除术与电切术后尿失禁发生率的随机对照研究.中华男科学杂志,2014,20(2):165-168.
[2]张运召,王军,马圣君,等.模型实验提示经尿道前列腺剜除术更容易造成术后尿失禁.中国继续医学教育,2015,7(14):121-122.
[3]许凯,刘春晓.经尿道双极等离子体前列腺剜除术治疗良性前列腺增生症1100例.实用医学杂志,2012,28(14):2395-2397.
[4]潘铁军,魏世平,文瀚东,等.经尿道等离子前列腺剜除术和前列腺电切术的疗效比较.中华男科学杂志,2012,18(2):179-181.
[5]杨帝宽,刘春晓.经尿道前列腺剜除术.中华腔镜泌尿外科杂志(电子版),2011,5(6):516-518.
[6]Lin Y,Wu X,Xu A,et al.Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia:a systematic review and meta-analysis of randomized controlled trials.World J Urol,2016,34(9):1207-1219.
[7]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.
[8]巩向文,刘伟光,高佃军,等.经尿道双极等离子前列腺剜除术与电切术术后尿失禁发生率比较.青岛大学医学院学报,2016,3(3):352-354.
[9]王世先,杨水法,杨恩明,等.不同前列腺体积采用经尿道双极等离子电切术与剜除术治疗的前瞻性对比研究(附521例报告).微创泌尿外科杂志,2016,5(3):145-149.
[10]Fine SW,Al-Ahmadie H,Gopalan A,et al.Anatomy of the anterior prostate and extraprostatic space:a contemporary surgical pathology analysis.Adv Anat Pathol,2007,14(6):401-407.
[11]白强,王振声,李青,等.保留尿道括约功能的前列腺癌根治术165例报告.中华泌尿外科杂志,2001,22(8):483-486.
[12]李海皓,王海峰,刘靖宇,等.术中主动保护尿控功能在经尿道前列腺钬激光剜除术中的应用疗效分析.临床泌尿外科杂志,2017,32(4):260-263.
[13]徐亚文,刘春晓,郑少波,等.经尿道前列腺腔内剜除术中保存前列腺前括约肌治疗低龄组前列腺增生患者的疗效观察.南方医科大学学报,2010,30(12):2708-2710.
[2]张运召,王军,马圣君,等.模型实验提示经尿道前列腺剜除术更容易造成术后尿失禁.中国继续医学教育,2015,7(14):121-122.
[3]许凯,刘春晓.经尿道双极等离子体前列腺剜除术治疗良性前列腺增生症1100例.实用医学杂志,2012,28(14):2395-2397.
[4]潘铁军,魏世平,文瀚东,等.经尿道等离子前列腺剜除术和前列腺电切术的疗效比较.中华男科学杂志,2012,18(2):179-181.
[5]杨帝宽,刘春晓.经尿道前列腺剜除术.中华腔镜泌尿外科杂志(电子版),2011,5(6):516-518.
[6]Lin Y,Wu X,Xu A,et al.Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia:a systematic review and meta-analysis of randomized controlled trials.World J Urol,2016,34(9):1207-1219.
[7]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.
[8]巩向文,刘伟光,高佃军,等.经尿道双极等离子前列腺剜除术与电切术术后尿失禁发生率比较.青岛大学医学院学报,2016,3(3):352-354.
[9]王世先,杨水法,杨恩明,等.不同前列腺体积采用经尿道双极等离子电切术与剜除术治疗的前瞻性对比研究(附521例报告).微创泌尿外科杂志,2016,5(3):145-149.
[10]Fine SW,Al-Ahmadie H,Gopalan A,et al.Anatomy of the anterior prostate and extraprostatic space:a contemporary surgical pathology analysis.Adv Anat Pathol,2007,14(6):401-407.
[11]白强,王振声,李青,等.保留尿道括约功能的前列腺癌根治术165例报告.中华泌尿外科杂志,2001,22(8):483-486.
[12]李海皓,王海峰,刘靖宇,等.术中主动保护尿控功能在经尿道前列腺钬激光剜除术中的应用疗效分析.临床泌尿外科杂志,2017,32(4):260-263.
[13]徐亚文,刘春晓,郑少波,等.经尿道前列腺腔内剜除术中保存前列腺前括约肌治疗低龄组前列腺增生患者的疗效观察.南方医科大学学报,2010,30(12):2708-2710.