TURP切除组织比例和切出腺窝形态与疗效关系的研究
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摘要
目的:1、研究不同前列腺腺窝形态模型之间尿流率的关系;2、探讨TURP切除不同比例组织和切出不同前列腺腺窝形态与疗效的关系。
材料和方法:1、模型试验:按不同容积制作四种两组玻璃腺窝形态模型;按不同横切面积制作五种两组树脂几何形态模型;在同一圆周径下按不同横切面积制作八种两组树脂不规则形态模型。比较各组不同形态模型之间尿流率的关系。2、临床观察:随访到TURP术后125例患者。按实际切除不同比例腺体组织分三组,即分别切除增生腺体的<40%组、40%-60%组、>60%组。按电切术后前列腺窝呈不同形态分两组即:圆筒状组、非圆筒状组。比较各组术前与术后IPSS评分、QOL评分、Qmax,以及各组术后并发症等疗效指标。
结果:1、模型实验:玻璃模型中Qmax总F=1.17,P=0.47;形态组间F=0.59,P=0.66;甲和乙组组间F=2.90,P=0.19;Qave总F=4.82,P=0.11;形态组间F=6.19,P=0.84;甲和乙组组间F=0.73,P=0.46。几何模型中Qmax总F=12.2,P=0.02;形态组间F=0.64,P=0.66;丙和丁组组间F=58.2,P=0.02;Qave总F=19.8,P=0.01;形态组间F=0.36,P=0.83;丙和丁组组间F=97.8,P=0.01。不规则模型中Qmax总F=204.5,P=0.00;形态组间F=53.2,P=0.00;戊和己组组间F=1263.5,P=0.00。Qave总F=79.4,P=0.00;形态组间F=28.2,P=0.00;戊和己组组间F=437.5,P=0.00。戊和己两组中J～O六个模型分别与P、Q两个模型的Qmax、Qave数据之间比较均P﹤0. 05。戊和己两组中J～O六个模型的Qmax、Qave数据之间比较均P﹥0. 05。戊和己两组中P与Q模型的Qmax、Qave数据之间比较均P﹥0. 05。2、临床观察:TURP切除组织比例(三组)术前年龄、前列腺体积、IPSS评分、QOL评分、Qmax之间比较均P﹥0. 05;切出腺窝形态(两组)术前年龄、前列腺体积、IPSS评分、QOL评分、Qmax之间比较均P﹥0. 05。TURP切除不同比例组织(三组)之间术前与术后疗效比较:各组IPSS评分、QOL评分、Qmax术前与术后比较均P﹤0. 05; <40%组分别与40%-60%组、>60%组术后IPSS评分、QOL评分、Qmax比较均P﹤0. 05; <40%组与>60%组术后IPSS评分、QOL评分、Qmax比较均P﹤0. 05;40%-60%组与>60%组术后IPSS评分、QOL评分、Qmax比较均P﹥0. 05。TURP切出不同腺窝形态(二组)术前与术后的疗效比较:两组IPSS评分、QOL评分、Qmax术前与术后比较均P﹤0. 05;圆筒状组与非圆筒状组术后IPSS评分、QOL评分、Qmax比较均P﹤0. 05; TURP切除不同比例(三组)并发症的比较:X2 =1.652,V=2,p=0.438。TURP切出不同前列腺腺窝形态(二组)并发症的比较:X2 =13.144,V=1,p=0.000。
结论:1、模型试验:玻璃模型实验中,恒定压力下,测定的尿流率数值与该组模型形态、容积无密切关系,而与该模型进出口径的大小及整个管道的最小径有关。几何树脂模型实验中,在恒定压力和相同截面积下,测定尿流率数值与该模型几何形态无密切关系。而横切面积大的模型组,尿流率的数值均大。不规则树脂模型组中,在恒定压力和相同外周径下,圆筒型或近似圆筒型该组模型所测定的尿流率数值均大。2、临床观察:TURP切除前列腺组织40%～60%比例与切出>60%比例的疗效相当。TURP切除组织40%～60%比切除组织<40%的疗效相对较好。TURP切出腺窝呈圆筒状或近似圆筒状通道时,疗效可靠。经尿道前列腺部分切除术,只要关键部位切除到位,手术即安全有效,同时并发症低,术后患者生活质量较好、疗效可靠。
Objective: 1、Study the relationship of urinary flow rate among different model of the prostate gland fossa. 2、Study the relationship of effect between the different proportion of excision、the different gland fossa of excision after TURP and the effect of treatment.
Materials and Methods: 1、Model experiment: According to different volume, producing four kinds, tow groups of the glass model of crypt shape; according to different cross-sectional area, making five kinds, tow groups of geometric shape-model made by resin; according to same circle but different cross-sectional area, making eight kinds, tow groups of geometric shape-model made by resin. Comparing the relationship of urinary flow rate between different shape of model in every group. 2、Clinical observation: Follow up 125 patients after TURP. According to different proportion of excision of the gland tissue, dividing the patients into three groups, they are <40% group, 40% -60% group, > 60% group. After TURP, according to different shape of prostate, dividing the patients into three groups, they are cylindrical group, non-cylinder-like group. Comparing IPSS score, QOL score, Qmax between preoperative and postoperative among groups, and the endpoint of postoperative complications.
Results: 1、Model experiment: In Glass model, Qmax total F = 1.17, P = 0.47; among the different form groups F = 0.59, P = 0.66; Qave total F = 4.82, P = 0.11, among the different form groups F = 0.73, P = 0.46. In Geometric model, Qmax total F = 12.2, P = 0.02; among the different form groups F = 0.64, P = 0.66; between group Bing and group Ding, F = 58.2, P = 0.02. Qave total F = 19.8, P = 0.01; among the different form groups F = 0.36, P = 0.83; between group Bing and group Ding, F = 97.8, P = 0.01. In Irregular model, Qmax total F = 204.5, P = 0.02; among the different form groups F = 53.2, P = 0.00; between group Wu and group Ji, F = 1263.5, P = 0.00. Qave total F=79.4,P=0.00; among the different form groups F=28.2,P=0.00; between group Wu and group Ji, F=437.5,P=0.00. Comparing the data of Qmax and Qave between 6 models J～O of group Wu and Ji, P<0. 05. Comparing the data of Qmax and Qave between group Wu and Ji with 6 models J～O , P﹥0. 05. Comparing the data of Qmax and Qave between P and Q of group Wu and group Ji, P﹥0. 05. 2、Clinical observation: The proportion of excision of preoperative(three group), compare the age, prostate volume, IPSS score, QOL score, Qmax, P﹥0. 05. The group of gland fossa of excision preoperative(two group), compare the age, prostate volume, IPSS score, QOL score, Qmax, P﹥0. 05. The data of the three groups that different proportion of excision, using analysis of variance of the randomized block design and tow-tow comparing, result: Comparing IPSS score, QOL score, Qmax between preoperative and postoperative each group, P<0. 05; Comparing group <40% and group 40%-60%, group >60% in postoperative, IPSS score, QOL score, Qmax, P<0. 05; Comparing group <40% and group >60% in postoperative, IPSS score, QOL score, Qmax, P<0. 05; Comparing group 40%-60% and group >60% in postoperative, IPSS score, QOL score, Qmax, P<0. 05. Comparing the effect between preoperative and postoperative, that different gland fossa of excision (tow groups):In tow groups IPSS score, QOL score, Qmax , compare between preoperative and postoperative, P<0. 05; Comparing IPSS score, QOL score, Qmax between group cylinder-shaped and group non-cylindrical shape postoperative P<0. 05. Comparing complications among the three groups that different proportion of excision: X2 =1.652, V=2, P=0.438. Comparing complications in the tow groups that different gland fossa of excision: X2 =13.144, V=1, P=0.000.
Conclusions: 1、Model experiment: In glass model experiments, constant pressure, there are no close relationship between the measured flow rate value and the group of shapes, volume, but there are no close relationship between the measured flow rate value and the size of export path of the models, the min-path of whole pipe. In geometric resin model experiment, in the constant pressure and the same cross-sectional area, there are no close relationship between the measured flow rate value and the geometry of the model. But when the cross-section area of the model group is large, urinary flow rate values also are large. In irregular resin model groups, in the constant pressure and the same outer circumference, it is large of flow rate values in the cylindrical or nearly cylindrical. 2、Clinical observation:It has the some effects between cut prostate tissue ratio of 40% -60%, and > 60% after TURP. The effect of cut prostate tissue ratio of 40% -60% after is better than that of <40%. When cut out cylindrical crypt or similar cylindrical channel after TURP, the effect is reliable. For TURP, when the key part is cut in place, the surgery is safe and effective, and the complication is less, postoperative quality of life of patients is better, and the effect is reliable.
材料和方法:1、模型试验:按不同容积制作四种两组玻璃腺窝形态模型;按不同横切面积制作五种两组树脂几何形态模型;在同一圆周径下按不同横切面积制作八种两组树脂不规则形态模型。比较各组不同形态模型之间尿流率的关系。2、临床观察:随访到TURP术后125例患者。按实际切除不同比例腺体组织分三组,即分别切除增生腺体的<40%组、40%-60%组、>60%组。按电切术后前列腺窝呈不同形态分两组即:圆筒状组、非圆筒状组。比较各组术前与术后IPSS评分、QOL评分、Qmax,以及各组术后并发症等疗效指标。
结果:1、模型实验:玻璃模型中Qmax总F=1.17,P=0.47;形态组间F=0.59,P=0.66;甲和乙组组间F=2.90,P=0.19;Qave总F=4.82,P=0.11;形态组间F=6.19,P=0.84;甲和乙组组间F=0.73,P=0.46。几何模型中Qmax总F=12.2,P=0.02;形态组间F=0.64,P=0.66;丙和丁组组间F=58.2,P=0.02;Qave总F=19.8,P=0.01;形态组间F=0.36,P=0.83;丙和丁组组间F=97.8,P=0.01。不规则模型中Qmax总F=204.5,P=0.00;形态组间F=53.2,P=0.00;戊和己组组间F=1263.5,P=0.00。Qave总F=79.4,P=0.00;形态组间F=28.2,P=0.00;戊和己组组间F=437.5,P=0.00。戊和己两组中J～O六个模型分别与P、Q两个模型的Qmax、Qave数据之间比较均P﹤0. 05。戊和己两组中J～O六个模型的Qmax、Qave数据之间比较均P﹥0. 05。戊和己两组中P与Q模型的Qmax、Qave数据之间比较均P﹥0. 05。2、临床观察:TURP切除组织比例(三组)术前年龄、前列腺体积、IPSS评分、QOL评分、Qmax之间比较均P﹥0. 05;切出腺窝形态(两组)术前年龄、前列腺体积、IPSS评分、QOL评分、Qmax之间比较均P﹥0. 05。TURP切除不同比例组织(三组)之间术前与术后疗效比较:各组IPSS评分、QOL评分、Qmax术前与术后比较均P﹤0. 05; <40%组分别与40%-60%组、>60%组术后IPSS评分、QOL评分、Qmax比较均P﹤0. 05; <40%组与>60%组术后IPSS评分、QOL评分、Qmax比较均P﹤0. 05;40%-60%组与>60%组术后IPSS评分、QOL评分、Qmax比较均P﹥0. 05。TURP切出不同腺窝形态(二组)术前与术后的疗效比较:两组IPSS评分、QOL评分、Qmax术前与术后比较均P﹤0. 05;圆筒状组与非圆筒状组术后IPSS评分、QOL评分、Qmax比较均P﹤0. 05; TURP切除不同比例(三组)并发症的比较:X2 =1.652,V=2,p=0.438。TURP切出不同前列腺腺窝形态(二组)并发症的比较:X2 =13.144,V=1,p=0.000。
结论:1、模型试验:玻璃模型实验中,恒定压力下,测定的尿流率数值与该组模型形态、容积无密切关系,而与该模型进出口径的大小及整个管道的最小径有关。几何树脂模型实验中,在恒定压力和相同截面积下,测定尿流率数值与该模型几何形态无密切关系。而横切面积大的模型组,尿流率的数值均大。不规则树脂模型组中,在恒定压力和相同外周径下,圆筒型或近似圆筒型该组模型所测定的尿流率数值均大。2、临床观察:TURP切除前列腺组织40%～60%比例与切出>60%比例的疗效相当。TURP切除组织40%～60%比切除组织<40%的疗效相对较好。TURP切出腺窝呈圆筒状或近似圆筒状通道时,疗效可靠。经尿道前列腺部分切除术,只要关键部位切除到位,手术即安全有效,同时并发症低,术后患者生活质量较好、疗效可靠。
Objective: 1、Study the relationship of urinary flow rate among different model of the prostate gland fossa. 2、Study the relationship of effect between the different proportion of excision、the different gland fossa of excision after TURP and the effect of treatment.
Materials and Methods: 1、Model experiment: According to different volume, producing four kinds, tow groups of the glass model of crypt shape; according to different cross-sectional area, making five kinds, tow groups of geometric shape-model made by resin; according to same circle but different cross-sectional area, making eight kinds, tow groups of geometric shape-model made by resin. Comparing the relationship of urinary flow rate between different shape of model in every group. 2、Clinical observation: Follow up 125 patients after TURP. According to different proportion of excision of the gland tissue, dividing the patients into three groups, they are <40% group, 40% -60% group, > 60% group. After TURP, according to different shape of prostate, dividing the patients into three groups, they are cylindrical group, non-cylinder-like group. Comparing IPSS score, QOL score, Qmax between preoperative and postoperative among groups, and the endpoint of postoperative complications.
Results: 1、Model experiment: In Glass model, Qmax total F = 1.17, P = 0.47; among the different form groups F = 0.59, P = 0.66; Qave total F = 4.82, P = 0.11, among the different form groups F = 0.73, P = 0.46. In Geometric model, Qmax total F = 12.2, P = 0.02; among the different form groups F = 0.64, P = 0.66; between group Bing and group Ding, F = 58.2, P = 0.02. Qave total F = 19.8, P = 0.01; among the different form groups F = 0.36, P = 0.83; between group Bing and group Ding, F = 97.8, P = 0.01. In Irregular model, Qmax total F = 204.5, P = 0.02; among the different form groups F = 53.2, P = 0.00; between group Wu and group Ji, F = 1263.5, P = 0.00. Qave total F=79.4,P=0.00; among the different form groups F=28.2,P=0.00; between group Wu and group Ji, F=437.5,P=0.00. Comparing the data of Qmax and Qave between 6 models J～O of group Wu and Ji, P<0. 05. Comparing the data of Qmax and Qave between group Wu and Ji with 6 models J～O , P﹥0. 05. Comparing the data of Qmax and Qave between P and Q of group Wu and group Ji, P﹥0. 05. 2、Clinical observation: The proportion of excision of preoperative(three group), compare the age, prostate volume, IPSS score, QOL score, Qmax, P﹥0. 05. The group of gland fossa of excision preoperative(two group), compare the age, prostate volume, IPSS score, QOL score, Qmax, P﹥0. 05. The data of the three groups that different proportion of excision, using analysis of variance of the randomized block design and tow-tow comparing, result: Comparing IPSS score, QOL score, Qmax between preoperative and postoperative each group, P<0. 05; Comparing group <40% and group 40%-60%, group >60% in postoperative, IPSS score, QOL score, Qmax, P<0. 05; Comparing group <40% and group >60% in postoperative, IPSS score, QOL score, Qmax, P<0. 05; Comparing group 40%-60% and group >60% in postoperative, IPSS score, QOL score, Qmax, P<0. 05. Comparing the effect between preoperative and postoperative, that different gland fossa of excision (tow groups):In tow groups IPSS score, QOL score, Qmax , compare between preoperative and postoperative, P<0. 05; Comparing IPSS score, QOL score, Qmax between group cylinder-shaped and group non-cylindrical shape postoperative P<0. 05. Comparing complications among the three groups that different proportion of excision: X2 =1.652, V=2, P=0.438. Comparing complications in the tow groups that different gland fossa of excision: X2 =13.144, V=1, P=0.000.
Conclusions: 1、Model experiment: In glass model experiments, constant pressure, there are no close relationship between the measured flow rate value and the group of shapes, volume, but there are no close relationship between the measured flow rate value and the size of export path of the models, the min-path of whole pipe. In geometric resin model experiment, in the constant pressure and the same cross-sectional area, there are no close relationship between the measured flow rate value and the geometry of the model. But when the cross-section area of the model group is large, urinary flow rate values also are large. In irregular resin model groups, in the constant pressure and the same outer circumference, it is large of flow rate values in the cylindrical or nearly cylindrical. 2、Clinical observation:It has the some effects between cut prostate tissue ratio of 40% -60%, and > 60% after TURP. The effect of cut prostate tissue ratio of 40% -60% after is better than that of <40%. When cut out cylindrical crypt or similar cylindrical channel after TURP, the effect is reliable. For TURP, when the key part is cut in place, the surgery is safe and effective, and the complication is less, postoperative quality of life of patients is better, and the effect is reliable.
引文
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[4].Ball AJ, Fenely RCL, Abuams PH: The natural history of untreated Prostatism [J]. Br,J , Urol. 1981;53;613.
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[1].张玉海,邹强主编.前列腺外科[M].北京:人民卫生出版社,2001,97～98.
[2].吴阶平主编.吴阶平泌尿外科学[M].济南:山东科学技术出版社,2004,1125～1234.
[3].顾方六,山岗志,王通生,等.北京城乡良胜前列腺增生发病的差异[J].中华泌尿外科杂志.1995, 16:387-390.
[4].Ball AJ, Fenely RCL, Abuams PH: The natural history of untreated Prostatism [J]. Br,J , Urol. 1981;53;613.
[5].顾方六。良性前列腺增生和前列腺癌的流行病学[J]。实用医学2000.12.25;16(12):977～978.
[6].Borborglu PG, Kane CJ, Ward JF, et al. Immediate and postoperative complications of transurethral prostatectomy in 1990s [J]. J Urol, 1999, 162:1307～1310.
[7].Wasson JH, Reda KJ, Bruskewitz RC, et al. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia .The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate [J]. New Engl J Med, 1995, 332:75～79.
[8].Yang Q,Peters TJ, Donowan JL, er al . Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials [J]. J Urol, 2001, 165: 1526～1532.
[9].Serretta V, Morgia G, Fondacaro L, et al. Members of the Sicilian-Calabrian Society of Urology. Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions [J]. Urology, 2002, 60: 623～627.
[10].Tubaro A, Carter S, Hind A, et al. A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patientswith benign prostatic hyperplasia [J]. J Urol, 2001, 166:172～176.
[11].Mebust WK, Transurethral surgery, In: Walsh PC, Retok AB, Vaughan ED. Wein AJ, eds. Campbell’s urology [M]. Vol 2.8th ed. Philadelphia: Saunders,2003,1479～1505.
[12].王行怀,王怀鹏,陈浩阳,等.经尿道等离子体双极电切术治疗良性前列腺增生及膀胱肿瘤[J].中华泌尿外科杂志,2003,24:318-320.
[13].Starkman JS, Santucci RA. Comparison of bipolar transurethral resection of the prostate with standard transurethral prostatectomy: shorter stay, earlier catheter remowal and fewer complications [J]. BJU Int,2005,95:69～71.
[14].Gilling PJ, Fraundorfer MR, Kabalin JB. Holmium: YAG laser resection of the prostate (HoLRP) versus transurethral electrocautery resection of the prostate (TURP): a prospective randomized, urodynamic-based clinical trial [J]. J Urol, 1997,157:149A.
[15].Alexis E, Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial [J]. J Urol,2004,172:1404～1408.
[16].孙颖浩,钱松溪,许传亮,等.Nd: YAG非接触式激光治疗前列腺增生(附32例报告)[J].中华泌尿外科杂志,1996,17,7:432～435.
[17].Kabalin JN.Neodymium: YAG laser coagulation prostatectomy for patients in urinary retention [J]. J Endourol, 1997,11:207～209.
[18].杨勇,彭发宝,魏志涛等。经尿道2μm激光前列腺汽化切除术治疗大体积良性前列腺增生的初步经验[J]。中华泌尿外科杂志,2009,30:198～200.
[19].Walmsley K, Kaplan SA. Transurethtal microwave thermotherapy for benign prostate hyperplasia: separating truth from marketing hype [J]. J Urol, 2004 ,172:1249～1255.
[20].Boyle P, Robertson C, Vaughan ED, et al. A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostaic hyperplasia [J]. BJU Int , 2004,94:83～88.
[21].张祥华分主编,良性前列腺增生诊断治疗指南[M]。见那彦群主编,中国泌尿外科疾病诊断治疗指南(2007版).人民卫生出版社.2007,7;167～204.
[22].梅骅,陈凌武,高新主编.泌尿外科手术学[M].第3版.北京:人民卫生出版社, 2008.1, 686～695、707.
[23].王可兵,周祥福,高新。经尿道前列腺电切术的几种方法[J/CD]。中华腔镜泌尿外科杂志:电子版.2008,2:65～69.
[24].Green J SA , Bose P , Thomas DP , et al. How complete is a transurethral resection of the prostate ? [J] Br J Urol , 1996 ,77∶398.
[25].孙颖浩等.前列腺部分电切术在高危前列腺增生症中的应用[J].中华泌尿外科杂志.1997,18(10):616～617.
[26].Trapasso J G, Irwin MB. Clinical outcome and reoperation after low weight transurethral resection of the prostate[J]. J Endourology 1994 ,8:165.
[27].钟惟德等.TURP治疗前列腺增生症不同质-积比值得疗效观察[J].实用医学杂志.2000,16(12):1000～1001.
[28].Berry SJ , Coffey DS , Walsh PC , et al. The development of human benign prostatic hyperplasia with age [J]. J Urol , 1984 ,132∶474.
[29].Meyhoff HH,Nordling J.Long term results of transurethral and transvesical prostatectomy [J]. Scand J Urol Nephrol.1986 ,20∶27.
[30].Roos NP , Wennberg J E , Malenka DJ , et al. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia[J]. N Engl J Med ,1989 ,320∶1120.
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