三种经尿道前列腺切除术治疗良性前列腺增生疗效比较
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摘要
目的:比较良性前列腺增生(BPH)的三种经尿道手术治疗效果。方法:分别采用经尿道前列腺电切术(TURP)、经尿道双极等离子前列腺切除术(PKRP)和经尿道铥激光前列腺切除术(TmLRP)治疗良性前列腺增生共137例。结果:三种术式患者手术前后前列腺症状评分(IPSS)、生活质量评分(QOLS)、残余尿(RUV)、最大尿流率(Qmax)比较均得到显著改善(P＜0.001),疗效满意,三组之间相比差异无显著性意义(P＞0.05)。前列腺重量(PW)＜40g时,TmLRP组手术时间明显短于PKRP和TURP组(P＜0.01),PKRP和TURP组之间相比无显著性意义(P＞0.05)。当40g＜PW＜50g时,三组手术时间相比无显著性意义(P＞0.05)。PW＞50g时TmLRP组手术时间明显长于PKRP和TURP组(P＜0.01),PKRP和TURP组之间相比无显著性意义(P＞0.05)。TmLRP组术中出血少于其它两组。术后膀胱冲洗时间、留管时间及住院时间等指标进行比较,结果分别为TmLRP组短于PKRP组,PKRP组短于TURP组(P＜0.01)。结论:三种经尿道手术方法都是治疗BPH的安全有效手段,TmLRP和PKRP比TURP更安全,术中及术后并发症更少。
Objectives:To compare clinical results of three therapies for benign prostatic hyperplasia(BPH).Methods:137 cases of BPH were treated with TURP,PKRP and TmLRP.Results:The general results were satisfactory.The IPSS,QOLS,RUV and Qmax had improved significantly(P＜0.001)in the postoperative period without any differences in either group(P＞0.05).When the prostate weight(PW)＜40g,The average period of operation time in TmLRP group were shorter than that in TURP and PKRP group(P＜0.01),and there was no significant difference between TURP and PKRP groups(P＞0.05).When the 40g＜PW＜50g,there was no significant difference among the three groups.When the PW＞50g,The average period of operation time in TmLRP group were longer than that in TURP and PKRP group(P＜0.01),and there was no significant difference between TURP and PKRP groups(P＞0.05).The average amount of bleeding were less in TmLRP group than in TURP and PKRP group;The mean catheterization and irrigation and hospital stay time in TmLRP were shorter than that in PKRP group and in PKRP were shorter than that in TURP group respectively(P＜0.01). Conclusions:Our results showed that the three therapies of the prostate were all safe and effective for transurethral resection of BPH with less intraoperative and postoperative complications,especially TmLRP and PKRP.
Objectives:To compare clinical results of three therapies for benign prostatic hyperplasia(BPH).Methods:137 cases of BPH were treated with TURP,PKRP and TmLRP.Results:The general results were satisfactory.The IPSS,QOLS,RUV and Qmax had improved significantly(P＜0.001)in the postoperative period without any differences in either group(P＞0.05).When the prostate weight(PW)＜40g,The average period of operation time in TmLRP group were shorter than that in TURP and PKRP group(P＜0.01),and there was no significant difference between TURP and PKRP groups(P＞0.05).When the 40g＜PW＜50g,there was no significant difference among the three groups.When the PW＞50g,The average period of operation time in TmLRP group were longer than that in TURP and PKRP group(P＜0.01),and there was no significant difference between TURP and PKRP groups(P＞0.05).The average amount of bleeding were less in TmLRP group than in TURP and PKRP group;The mean catheterization and irrigation and hospital stay time in TmLRP were shorter than that in PKRP group and in PKRP were shorter than that in TURP group respectively(P＜0.01). Conclusions:Our results showed that the three therapies of the prostate were all safe and effective for transurethral resection of BPH with less intraoperative and postoperative complications,especially TmLRP and PKRP.
引文
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[2]Gordon NS,Hadlow G;Knight E,et al.Transurethral resection of the prostate:still thegold standard[J].Aust N Z J Surg,1997,67:354-357.
[3]Saad F,Carrier S,Jolivet-T remblay M.Comparison of prostatic electro-vaporizationand transurethral Resection in the treatment of benign prostatic hypertrophy[J].AnnChir J,1997,51:884-886.
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[7]沈文浩,熊恩庆,宋波,等.前列腺钬激光剜除术治疗良性前列腺增生近期疗效观察[J].中华泌尿外科杂志,2005,1(26):20-23.
[8]韩见知,庄乾元.实用腔内泌尿外科学[M].广州:广东科技出版社,2001:353-375.
[9]Kollmorgan TA,Malek RS.Laser prostatectomy,two and half years'experience withaggressive multifocal therapy[J].Adult Urol,1996,48:217-222.
[10]Malek RS,Barrett.D M.High power potassium phosphate(KPT/532)laservaporization prostatectomy:24hours later[J].Adult Urol,1998,51:254-256.
[11]Fried NM.High power laser vaporization of the canine prostate using A 110WThulium fiber laser at 1.91mum[J].Lasers Surg Med,2005,36:52-56.
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[13]Botto H,Lebret T,Barre P,et al.Electrovaporization of the prostate with the Gyrusdevice[J].Endo urol,2001,15:313-316.
[14]Mebust W,Hltgrewe H,Cocket APC,et al.Transurethral prostatectomy:immediateand postoperative complication.A comparative study of 13 participation institution evaluating 3885 patients[J].urol J,1989,141:243-247.
铩颷15]Dunsmuir WD,Me Farlane JP,Tan A,et al.Gyrus bipolar eletrovaporization vstransurethral resection of the prostate:a randomized prospective single blind trial withly follow up[J].Prostate Cancer Prostatic Dis,2003,6(2):182-186.
[16]Muslumanoglu AY,Tefekli A,Altttrtrende F.et al.758 Transurethral prostate surgeryusing gyrus device(plasmakinetic)in men with BPH[J].EU J Urol Sup,2004,3(2):192.
[17]Pu X,Wang X,Wang H,et al.Erectile dysfunction after PlasmaKinetic vaporizationof the prostate:incidence and risk factors[J].Endourol J.2006,20(9):693-697.
[18]Marco de Sio,Riccardo Autorino,Giuseppe Quarto,et al.Gyrus bipolar versusstandard monopolar transurethral resection of the prostate:A randomized prospectivetrial[J].Italy,Urol,2006,67(1):69-72.
[19]de Sio M,Autorino R,Quarto G,et al.Gyrus bipolar versus standard monopolartransurethral resection of the prostate:a randomized prospective trial[J].Urol J.2006,67(1):69-72.
[20]Karaman MI,Kaya C,Ozturk M,et al.Comparison of transurethral vaporizationusing PlasmaKinetic energy and transurethral resection of prostate:1-yearfollow-up[J].Endourol.2005,19(6):734-737.
[21]Hon NH,Brathwaite D,Hussain Z,et al.A prospective,randomized trial comparingconventional transurethral prostate resection with PlasmaKinetic vaporization of theprostate physiological changes,early complications and:long-term follow up[J].Urol,2006,176(1):205-209.
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