经尿道前列腺等离子电切和剜除术的疗效及学习曲线分析
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摘要
目的对比分析前列腺等离子电切术(bipolar transurethral plas-makinetic resection of the prostate,PKRP)与前列腺等离子剜除术(plasmakinetic enucleation of the prostate,PKEP)治疗前列腺增生(benign prostatic hyperplasia,BPH)的安全性、有效性及学习曲线。方法对我院自2016年1月至2017年4月收治的44例前列腺增生患者进行围手术期评估并随机分组。剔除前列腺肿瘤2例,最终入组PKRP组患者20例,年龄62~85岁,平均(69.22±5.98)岁;前列腺质量30.40~80.92g,平均(56.72±12.00)g。PKEP组患者22例,年龄60~83岁,平均(72.40±4.99)岁,前列腺质量36.04~74.30g,平均(54.61±10.82)g。两组患者年龄、前列腺质量差异无统计学意义,均由有电切经验的高年资主治医师手术,手术顺利完成。术前、术后3个月问卷调查国际前列腺症状评分(IPSS)、生活质量评分(QoL),尿动力学检查测定最大尿流率(Q_(max))。记录手术时间、手术出血量、术后导尿管留置时间、手术并发症等相关参数。结果两组患者术前IPSS、Qo L、Q_(max)差异无统计学意义(P>0.05)。术后3个月IPSS、Qo L、Q_(max)两组比较差异也无统计学意义(P>0.05)。两组手术后3个月IPSS、Qo L较术前下降,Q_(max)较术前上升,组内IPSS、Qo L、Q_(max)术前及术后3个月差异有统计学意义(P<0.05)。切除组织质量上PKRP组少于PKEP组,手术时长、术中出血量、膀胱冲洗时长上PKRP组大于PKEP组,差异有统计学意义(P<0.05)。结论 PKRP和PKEP在对BPH患者的治疗是安全有效的。PKEP因其特性切除腺体更彻底、出血少、手术时间短,对大体积前列腺更有优势。通过学习曲线来看,在有TURP的基础上不难掌握,值得推广。
Objective To evaluate the safety,curative effect and learning curve of Bipolar transurethral PlasmaKinetic resection of the prostate(PKRP) and plasmakinetic enucleation of the prostate(PKEP).Methods Forty-four patients with benign prostatic hyperplasia admitted in our hospital from January 2016 to April 2017 were enrolled and randomly grouped.Two cases of prostate cancer were excluded.The number of patients in PKRP group was 20 patients aged 60~85years(mean 69.22±5.98 years).Their prostate weight was 30.40-80.92 g,with an average of 56.72±12.00 g.The number of patients in PKEP group was 22 patients,aged 60~83 years,mean 72.40±4.99 years old,their prostate weight 36.04~74.30 g,an average of 54.61±10.82 g.There were no significant differences in the age and prostate weight between the two groups.The operations of all the patients were successfully completed by high-grade physician.A questionnaire survey preoperative and 3 months postoperative was carried out including international prostate symptom score(IPSS),quality of life score(QoL),urodynamic examination to determine the maximum urinary flow rate(Qmax).Record the operation time,the amount of surgical bleeding,postoperative catheter catheterization time,surgical complications and other related parameters.Results There were dramatic improvements significant difference in IPSS,QoL and Qmax in both groups after the treatment(P <0.05).But no significant difference was observed between the two groups(P>0.05).The weight of the resected tissue was lower in the PKRP group than in the PKEP group.The length of operation,the amount of intraoperative blood loss,and the duration of bladder irrigation were greater in the PKRP group than in the PKEP group(P <0.05).Conclusion PKRP and PKEP is safe and effective in the treatment of patients with benign prostatic hyperplasia.PKEP show more advantages for treatment of large-size prostate due to its characteristics such as more thorough removal of the gland,less bleeding,shorter operative time.From the point of learning curve view,this method is worth promoting in clinic based on the basis of TURP and easy to operate
Objective To evaluate the safety,curative effect and learning curve of Bipolar transurethral PlasmaKinetic resection of the prostate(PKRP) and plasmakinetic enucleation of the prostate(PKEP).Methods Forty-four patients with benign prostatic hyperplasia admitted in our hospital from January 2016 to April 2017 were enrolled and randomly grouped.Two cases of prostate cancer were excluded.The number of patients in PKRP group was 20 patients aged 60~85years(mean 69.22±5.98 years).Their prostate weight was 30.40-80.92 g,with an average of 56.72±12.00 g.The number of patients in PKEP group was 22 patients,aged 60~83 years,mean 72.40±4.99 years old,their prostate weight 36.04~74.30 g,an average of 54.61±10.82 g.There were no significant differences in the age and prostate weight between the two groups.The operations of all the patients were successfully completed by high-grade physician.A questionnaire survey preoperative and 3 months postoperative was carried out including international prostate symptom score(IPSS),quality of life score(QoL),urodynamic examination to determine the maximum urinary flow rate(Qmax).Record the operation time,the amount of surgical bleeding,postoperative catheter catheterization time,surgical complications and other related parameters.Results There were dramatic improvements significant difference in IPSS,QoL and Qmax in both groups after the treatment(P <0.05).But no significant difference was observed between the two groups(P>0.05).The weight of the resected tissue was lower in the PKRP group than in the PKEP group.The length of operation,the amount of intraoperative blood loss,and the duration of bladder irrigation were greater in the PKRP group than in the PKEP group(P <0.05).Conclusion PKRP and PKEP is safe and effective in the treatment of patients with benign prostatic hyperplasia.PKEP show more advantages for treatment of large-size prostate due to its characteristics such as more thorough removal of the gland,less bleeding,shorter operative time.From the point of learning curve view,this method is worth promoting in clinic based on the basis of TURP and easy to operate
引文
1 Zwergel U,Wullich B,Lindenmeir U,et al.Longterm results following transurethral resection of the prostate.Eur Urol 1998;33(5):476-480
2 Hu Y,Dong X,Wang G,et al.Five-Year Follow-Up Study of Transurethral Plasmakinetic Resection of the Prostate for BenignProstatic Hyperplasia.J Endourol 2016;30(1):97-101
3 Li S,Kwong JS,Zeng XT,et al.Plasmakinetic resection technology for the treatment of benign prostatic hyperplasia:evidence from a systematic review and metaanalysis.Sci Rep 2015;5:12002
4 Sinanoglu O,Ekici S,Balci MC,et al.Comparison of plasmakinetic transurethral resection of the prostate with monopolar transurethral resection of the prostate in terms of urethral stricture rates in patients with comorbidities.Prostate Int 2014;2(3):121-126
5 Wang K,Li Y,Teng JF,et al.Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia:a meta-analysis of randomized controlled trials.Asian J Androl 2015;17(1):135-142
6 Karadag MA,Cecen K,Demir A,et al.Plasmakinetic vaporization versus plasmakinetic resection to treat benign prostatic hyperplasia:A prospective randomized trial with 1 year follow-up.Can Urol Assoc J 2014;8(9-10):E595-E599
7 Long Z,Zhang YC,He LY,et al.Comparison of transurethral plasmakinetic and transvesical prostatectomy in treatment of 100-149 mL benign prostatic hyperplasia.Asian J Surg 2014;37(2):58-64
8 Fagerstr?m T,Nyman CR,Hahn RG.Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate.J Endourol 2011;25(6):1043-1049
9 Zhang KY,Xing JC,Chen BS,et al.Bipolar plasmakinetic transurethral resection of the prostate vs.transurethral enucleation and resection of the prostate:pre-and postoperative comparisons of parameters used in assessing benign prostatic enlargement.Singapore Med J2011;52(10):747-687514
10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):352-354,358
11 Xu N,Chen SH,Xue XY,et al.Older Age and Larger Prostate Volume Are Associated with Stress Urinary Incontinence after Plasmakinetic Enucleation of the Prostate.Biomed Res Int 2017;2017:6923290
12张杰,龚旻,朱汝健,等.三种不同腔内技术治疗高危重度前列腺增生的比较研究.中国男科学杂志2016;30(12):26-31
13 Geavlete B,Stanescu F,Iacoboaie C,et al.Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases-a medium term,prospective,randomized comparison.BJU Int 2013;111(5):793-803
14贺晓龙,宋红雄,强亚勇,等.两种经尿道等离子术式治疗良性前列腺增生症临床对比研究.中国男科学杂志2016;30(5):47-50
15刘宏伟,左玲,柳建军,等.经尿道等离子前列腺剜除术与电切术治疗大体积前列腺增生疗效比较.中国男科学杂志2015;29(11):45-48,52
2 Hu Y,Dong X,Wang G,et al.Five-Year Follow-Up Study of Transurethral Plasmakinetic Resection of the Prostate for BenignProstatic Hyperplasia.J Endourol 2016;30(1):97-101
3 Li S,Kwong JS,Zeng XT,et al.Plasmakinetic resection technology for the treatment of benign prostatic hyperplasia:evidence from a systematic review and metaanalysis.Sci Rep 2015;5:12002
4 Sinanoglu O,Ekici S,Balci MC,et al.Comparison of plasmakinetic transurethral resection of the prostate with monopolar transurethral resection of the prostate in terms of urethral stricture rates in patients with comorbidities.Prostate Int 2014;2(3):121-126
5 Wang K,Li Y,Teng JF,et al.Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia:a meta-analysis of randomized controlled trials.Asian J Androl 2015;17(1):135-142
6 Karadag MA,Cecen K,Demir A,et al.Plasmakinetic vaporization versus plasmakinetic resection to treat benign prostatic hyperplasia:A prospective randomized trial with 1 year follow-up.Can Urol Assoc J 2014;8(9-10):E595-E599
7 Long Z,Zhang YC,He LY,et al.Comparison of transurethral plasmakinetic and transvesical prostatectomy in treatment of 100-149 mL benign prostatic hyperplasia.Asian J Surg 2014;37(2):58-64
8 Fagerstr?m T,Nyman CR,Hahn RG.Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate.J Endourol 2011;25(6):1043-1049
9 Zhang KY,Xing JC,Chen BS,et al.Bipolar plasmakinetic transurethral resection of the prostate vs.transurethral enucleation and resection of the prostate:pre-and postoperative comparisons of parameters used in assessing benign prostatic enlargement.Singapore Med J2011;52(10):747-687514
10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):352-354,358
11 Xu N,Chen SH,Xue XY,et al.Older Age and Larger Prostate Volume Are Associated with Stress Urinary Incontinence after Plasmakinetic Enucleation of the Prostate.Biomed Res Int 2017;2017:6923290
12张杰,龚旻,朱汝健,等.三种不同腔内技术治疗高危重度前列腺增生的比较研究.中国男科学杂志2016;30(12):26-31
13 Geavlete B,Stanescu F,Iacoboaie C,et al.Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases-a medium term,prospective,randomized comparison.BJU Int 2013;111(5):793-803
14贺晓龙,宋红雄,强亚勇,等.两种经尿道等离子术式治疗良性前列腺增生症临床对比研究.中国男科学杂志2016;30(5):47-50
15刘宏伟,左玲,柳建军,等.经尿道等离子前列腺剜除术与电切术治疗大体积前列腺增生疗效比较.中国男科学杂志2015;29(11):45-48,52