经尿道前列腺等离子双极电切术对良性前列腺增生合并逼尿肌功能障碍患者的临床疗效研究

摘要

Objective: To investigate the clinical effect of transurethral plasmakinetic resection of prostate (PKRP) for benign prostatic hyperplasia (BPH) with acontractile detrusor.Methods: Comparative studies were performed in 74 cases of benign prostatic hyperplasia with acontractile detrusor before and after PKRP, and then analysed and assessed the indicators of urodynamics and IPSS.Results: The detrusor function recovered gradually in 94.6% patients after surgery.The strength of the bladder detrusor contraction increased after operation.The maximum flow rate increased significantly after operation with Qmax of (12.4±3.5)L/s, compared with (5.6±2.7)L/s before treatment.Postvoid residual urine (PVR) decreased obviously after treatment (261±59)mL vs.(47±32)mL, P<0.05).Postoperative IPSS was (9.6±5.1), compared with (25.2±7.9) before operation (P<0.05).Only 4 patients experienced temporary incontinence.Conclusions: BPH patients with acontractile detrusor comfirmed by urodynamics test that were found to have no peripheral neuropathy in further examination could benefit from PKRP, because the surgery could relieve the obstruction and be conducive to the recovery of detrusor function.%目的:探讨经尿道前列腺等离子双极电切术(PKRP)对合并逼尿肌功能障碍的良性前列腺增生(BPH)患者的临床治疗效果.方法:对存在逼尿肌功能障碍的74例BPH患者进行术前、术后尿流动力学检查及国际前列腺症状评分(IPSS)并分析结果.结果:94.6%的患者术后逼尿肌功能逐渐得到恢复,膀胱逼尿肌收缩力较术前增强,其中最大尿流率(Qmax)(12.4±3.5)ml/s,较手术前的(5.6±2.7)ml/s明显提高(P<0.05);剩余尿量(PVR)术前(261±59)ml,术后(47±32)ml,明显降低(P<0.05),术前IPSS为(25.2±7.9)分,术后下降至(9.6±5.1)分,PKRP术后仅4例出现暂时性尿失禁,患者总体临床症状获得明显改善(P<0.05).结论:对于术前行尿流动力学检测发现的合并有逼尿肌功能障碍的BPH患者,如果进一步检查未发现外周神经病变,行PKRP手术在解除梗阻的同时有利于逼尿肌功能的恢复.