经尿道等离子体前列腺剜除术和切除术运用于Ⅳ度前列腺增生的对比研究

摘要

目的比较经尿道等离子体前列腺剜除术(PKEP)与经尿道等离子体前列腺切除术(PKRP)在Ⅳ度良性前列腺增生(BPH)的临床疗效。方法将具有手术指征的100例Ⅳ度 BPH患者随机分为两组,分别行 PKEP 和 PKRP,监测记录患者围手术期和术后随访1年的临床资料(包括手术时间、切除前列腺重量、术中出血量、术后膀胱冲洗时间、留置尿管时间和住院时间,以及术后1年国际前列腺症状评分、生活质量评分、残余尿量、最大尿流率),对所测指标行统计学分析。结果术前两组一般情况(年龄、前列腺大小、合并症情况等)比较,差异无统计学意义(P >0.05)；PKRP组、PKEP 组术中出血量、手术时间、术后平均膀胱冲洗时间、置管时间和住院时间分别为(180.5±15.2)和(110.3±14.8)ml、(95.1±4.5)和(70.4暲4.6)min、(3.6±1.5)和(3.0±1.4)d、(5.1±1.0)和(4.4±0.7)d、(7.5±1.4)和(6.2±1.5)d,以上指标 PKEP 组明显少于 PKRP 组(P <0.05),切除前列腺重量 PKEP 组[(60.5±3.4)g]明显多于 PKRP 组[(54.0±3.6)g],术后1年两组患者残余尿量、最大尿流率均比术前明显改善(P <0.05)。结论 PKEP 治疗 BPH 具有与 PKRP 相近的近期疗效,而患者术中并发症发生率、恢复时间 PKEP 组明显少于 PKRP 组,PKEP 可安全、有效治疗 BPH,可作为手术治疗 BPH 的一种选择。%Objective To compare the clinical efficacy and safety of transurethral plasmakinet-ic enucleation of prostate (PKEP)and transurethral plasmakinetic resection of prostate (PKRP)in the treatment of degree Ⅳ benign prostatic hyperplasia (BPH). Methods 100 patients with degree Ⅳ BPH who had surgical indications were randomized into two groups:PKEP group and PKRP group.The preoperative international prostate symptom score (IPSS),the quality of life,post-void residual urine volume (PVR),quantity of maximum flow rate (Qmax),the operation time,blood loss,weight of prostate,mean catheterization time,and hospitalization time were compared.Pa-tients were followed up one year after the operation and IPSS,PVR and Qmax were observed. Results There was no significant difference in preoperative factors between the two groups (P >0.05).The mean operation time (70.4±4.6 min vs 95.1 ±4.5 min),bladder irrigating time (3.0±1.4 d vs 3.6 ± 1.5 d),hemorrhage (1 10.3 ± 14.8 ml vs 180.5 ±1 5.2 ml),catheterization time (4.4±0.7 d vs 5.1±1.0 d)and hospitalization time (6.2±1.5 d vs 7.5±1.4 d)were signifi-cantly less in the PKEP group than in the PKRP group (P <0.05).The mean resected tissues weighted more in the PKEP group (60.5±3.4 g)than in the PKRP group (54.0±3.6 g)(P <0.05).One year after operation,PVR and Qmax in both groups were improved singnificantly. Conclusions PKEP is as effective as PKRP for the treatment of symptomatic BPH.Transurethral PKEP is a safe,effec-tive surgical method to be chosen for the treatment of BPH.