经尿道前列腺等离子双极电切与经尿道前列腺汽化电切术治疗大体积前列腺增生的疗效比较及术后尿道狭窄的原因分析与防治体会
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摘要
目的探讨经尿道前列腺等离子双极电切(PKRP)与经尿道前列腺汽化电切术(TUVP)治疗大体积前列腺增生的疗效及术后尿道狭窄的原因分析与防治方法。方法 60例大体积(前列腺重量均≥100 g)前列腺增生患者,随机分为PKRP组和TUVP组,各30例。PKRP组应用PKRP进行治疗,TUVP组应用TUVP进行治疗,比较两组的临床疗效及尿道狭窄发生情况,并对发生原因及防治情况进行分析。结果 PKRP组手术时间明显短于TUVP组,冲洗液量、术中出血量和血红蛋白(Hb)下降值低于TUVP组,腺体切除量多于TUVP组,差异有统计学意义(P<0.05)。两组尿管留置时间、住院时间比较,差异无统计学意义(P>0.05)。PKRP组发生尿道狭窄1例,明显少于TUVP组的7例,差异具有统计学意义(P<0.05)。术后尿道狭窄患者采取经尿道扩张术(3例)、尿道外口成形术(2例)、尿道内钬激光切开术(1例)、尿道内口电切术(2例)治疗后排尿困难症状消失。术后随访12个月,所有患者均治愈,无复发。结论治疗大体积前列腺增生时,PKRP比TUVP优势更明显,可缩短手术时间,减少术中出血量,并能有效减少术后尿道狭窄的发生,采用积极有效的防治方法可防治术后尿道狭窄。
Objective To compare the curative effect of transurethral bipolar plasmakinetic resection of prostate(PKRP)and transurethral vaporization of the prostate(TUVP) in the treatment of large volume prostatic hyperplasia, causes analysis of postoperative urethral stricture and their prevention and treatment method. Methods A total of 60 patients with large volume(the prostate weight≥100 g) prostatic hyperplasiawere randomly divided into PKRP group and TUVP group, 30 cases in each group.The PKRP group was treated with PKRP, the TUVP group was treated with TUVP. The curative effect and incidence of urethral stricture were compared between the two groups, and the causes and prevention and treatment were analyzed. Results The operative time of PKRP group was significantly shorter than that of TUVP group, the flushing volume, intraoperative blood loss and the decreased value of hemoglobin(Hb) in PKRP group were significantly lower than those in TUVP group, the amount of adenectomy in PKRP group was significantly greater than that of TUVP group, the differences were statistically significant(P<0.05). There was no significant difference between the two groups in the indwelling time of urethral catheter and length of stay between the two groups(P>0.05). There was 1 case of urethral stricture in PKRP group, which was significantly less than 7 cases in TUVP group, the difference was statistically significant(P<0.05). After surgery, 3 cases of urethral stricture were treated by transurethral dilatation, 2 cases of urethral stricture were treated by external urethroplasty, 1 case of urethral stricture was treated by urethral holmium laser excision, 2 cases of urethral stricture were treated by internal urethrotomy, the dysuria symptoms disappeared after treatment. After 12 months of follow-up, all patients were cured without recurrence.Conclusion In the treatment of large volume prostatic hyperplasia, PKRP has more obvious advantages than TUVP. It can shorten the operative time, reduce intraoperative blood loss, and can effectively reduce the incidence of postoperative urethral stricture. The postoperative urethral stricture can be prevented by positive and effective methods of prevention and control.
Objective To compare the curative effect of transurethral bipolar plasmakinetic resection of prostate(PKRP)and transurethral vaporization of the prostate(TUVP) in the treatment of large volume prostatic hyperplasia, causes analysis of postoperative urethral stricture and their prevention and treatment method. Methods A total of 60 patients with large volume(the prostate weight≥100 g) prostatic hyperplasiawere randomly divided into PKRP group and TUVP group, 30 cases in each group.The PKRP group was treated with PKRP, the TUVP group was treated with TUVP. The curative effect and incidence of urethral stricture were compared between the two groups, and the causes and prevention and treatment were analyzed. Results The operative time of PKRP group was significantly shorter than that of TUVP group, the flushing volume, intraoperative blood loss and the decreased value of hemoglobin(Hb) in PKRP group were significantly lower than those in TUVP group, the amount of adenectomy in PKRP group was significantly greater than that of TUVP group, the differences were statistically significant(P<0.05). There was no significant difference between the two groups in the indwelling time of urethral catheter and length of stay between the two groups(P>0.05). There was 1 case of urethral stricture in PKRP group, which was significantly less than 7 cases in TUVP group, the difference was statistically significant(P<0.05). After surgery, 3 cases of urethral stricture were treated by transurethral dilatation, 2 cases of urethral stricture were treated by external urethroplasty, 1 case of urethral stricture was treated by urethral holmium laser excision, 2 cases of urethral stricture were treated by internal urethrotomy, the dysuria symptoms disappeared after treatment. After 12 months of follow-up, all patients were cured without recurrence.Conclusion In the treatment of large volume prostatic hyperplasia, PKRP has more obvious advantages than TUVP. It can shorten the operative time, reduce intraoperative blood loss, and can effectively reduce the incidence of postoperative urethral stricture. The postoperative urethral stricture can be prevented by positive and effective methods of prevention and control.
引文
[1]Kan CF,Tsu HL,Chiu Y,et al.A prospective study comparing bipolar endoscopic enucleation of prostate with bipolar transurethral resection in saline for management of symptomatic benign prostate enlargement larger than 70 g in a matched cohort.International Urology&Nephrology,2013,46(3):511-517.
[2]Ran L,He W,Zhu X,et al.Comparison of fluid absorption between transurethral enucleation and transurethral resection for benign prostate hyperplasia.Urologia Internationalis,2013,91(1):26-30.
[3]余昆,李风,石国忠,等.经尿道电切术治疗表浅性膀胱癌合并良性前列腺增生的临床分析.局解手术学杂志,2012,21(5):556-558.
[4]Badmus TA,Asaleye CM,Badmus SA,et al.Benign prostate hyperplasia:average volume in southwestern Nigerians and correlation with anthropometrics.Nigerian Postgraduate Medical Journal,2013,20(1):52-56.
[5]龚旻,伊庆同,胡巍,等.经尿道前列腺电汽化术及等离子电切术后5年疗效随访.中华泌尿外科杂志,2012,33(5):364-368.
[6]Liao N,Yu J.A study comparing plasmakinetic enucleation with bipolar plasmakinetic resection of the prostate for benign prostatic hyperplasia.Journal of Endourology,2012,26(7):884.
[7]Neill MG,Gilling PJ,Kennett KM,et al.Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia.Urology,2006,68(5):1020-1024.
[8]张海彬,王家强,孙文清.良性前列腺增生微创治疗研究进展.中国老年学杂志,2012(7):1279-1282.
[9]Xiong W,Sun M,Ran Q,et al.Learning curve for bipolar transurethral enucleation and resection of the prostate in saline for symptomatic benign prostatic hyperplasia:experience in the first100 consecutive patients.Urologia Internationalis,2013,90(1):68.
[10]Gilling PJ.Laser Enucleation Is Increasingly Becoming the Standard of Care for Treatment of Benign Prostatic Hyperplasia of All Sizes.European Urology,2013,63(5):868-869.
[11]游志勇,俞金水,刘振明.经尿道双极等离子体前列腺剜除术治疗大体积高危体积前列腺增生.中国医药指南,2014,12(4):123-124.
[12]Martin S,Lange K,Haren M T,et al.Risk factors for progression or improvement of lower urinary tract symptoms in a prospective cohort of men.Journal of Urology,2014,191(1):130.
[13]王朝,盛玉文,刘奔,等.经尿道前列腺双极等离子腔内剜除术治疗大体积良性前列腺增生的临床疗效.北京医学,2014,36(2):102-105.
[14]Yang SS,Hsieh CH,Lee YS,et al.Diode laser(980 nm)enucleation of the prostate:a promising alternative to transurethral resection of the prostate.Lasers in Medical Science,2013,28(2):353.
[2]Ran L,He W,Zhu X,et al.Comparison of fluid absorption between transurethral enucleation and transurethral resection for benign prostate hyperplasia.Urologia Internationalis,2013,91(1):26-30.
[3]余昆,李风,石国忠,等.经尿道电切术治疗表浅性膀胱癌合并良性前列腺增生的临床分析.局解手术学杂志,2012,21(5):556-558.
[4]Badmus TA,Asaleye CM,Badmus SA,et al.Benign prostate hyperplasia:average volume in southwestern Nigerians and correlation with anthropometrics.Nigerian Postgraduate Medical Journal,2013,20(1):52-56.
[5]龚旻,伊庆同,胡巍,等.经尿道前列腺电汽化术及等离子电切术后5年疗效随访.中华泌尿外科杂志,2012,33(5):364-368.
[6]Liao N,Yu J.A study comparing plasmakinetic enucleation with bipolar plasmakinetic resection of the prostate for benign prostatic hyperplasia.Journal of Endourology,2012,26(7):884.
[7]Neill MG,Gilling PJ,Kennett KM,et al.Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia.Urology,2006,68(5):1020-1024.
[8]张海彬,王家强,孙文清.良性前列腺增生微创治疗研究进展.中国老年学杂志,2012(7):1279-1282.
[9]Xiong W,Sun M,Ran Q,et al.Learning curve for bipolar transurethral enucleation and resection of the prostate in saline for symptomatic benign prostatic hyperplasia:experience in the first100 consecutive patients.Urologia Internationalis,2013,90(1):68.
[10]Gilling PJ.Laser Enucleation Is Increasingly Becoming the Standard of Care for Treatment of Benign Prostatic Hyperplasia of All Sizes.European Urology,2013,63(5):868-869.
[11]游志勇,俞金水,刘振明.经尿道双极等离子体前列腺剜除术治疗大体积高危体积前列腺增生.中国医药指南,2014,12(4):123-124.
[12]Martin S,Lange K,Haren M T,et al.Risk factors for progression or improvement of lower urinary tract symptoms in a prospective cohort of men.Journal of Urology,2014,191(1):130.
[13]王朝,盛玉文,刘奔,等.经尿道前列腺双极等离子腔内剜除术治疗大体积良性前列腺增生的临床疗效.北京医学,2014,36(2):102-105.
[14]Yang SS,Hsieh CH,Lee YS,et al.Diode laser(980 nm)enucleation of the prostate:a promising alternative to transurethral resection of the prostate.Lasers in Medical Science,2013,28(2):353.