整体剜除联合耻骨上穿刺旋切治疗大体积(>80ml)前列腺增生症  

Transurethral Enucleation with Pneumo-cystostomy Rotary Resection for Large Benign Prostatic Hyperplasia( More Than 80ml)

作　　者：朱明德[1] 董焱鑫[1] 杨军昌[1] 高晓康[1] 曾锐[1] 霍双进 李东[1] 尼加提[1] 

机构地区：[1]兰州军区乌鲁木齐总医院泌尿外科,乌鲁木齐830000

出　　处：《中国微创外科杂志》2016年第4期297-300,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经尿道腔内整体剜除联合耻骨上穿刺气膀胱下子宫肌瘤旋切器切割、取出前列腺治疗大体积（〉80 ml）前列腺增生症（benign prostatic hyperplasia,BPH）的临床效果。方法 2011年11月～2015年5月按时间段将55例大体积BPH分为2组：旋切组35例（2013年6月～2015年5月）,经尿道腔内整体剜除前列腺,完整剜除后推入膀胱,耻骨上造瘘插入子宫肌瘤旋切器,连接气腹机,在气膀胱下将剜除的腺体旋切成大块条状取出;小切口组20例（2011年11月～2013年5月）,经尿道腔内分叶剜除前列腺,推入膀胱,下腹膀胱作小切口取出。结果 55例均顺利完成手术。旋切组手术时间（45.5±15.2）min,与小切口组（43.8±13.4）min无统计学差异（t=0.416,P=0.679）;旋切组术中出血量（54.8±12.7）ml,与小切口组（53.7±11.5）ml无统计学差异（t=0.319,P=0.751）;术后膀胱冲洗时间（25.3±6.7）h,与小切口组（26.8±7.0）h无统计学差异（t=0.786,P=0.435）;国际前列腺症状评分（IPSS）（6.6±3.3）分,与小切口组（6.7±3.2）分无统计学差异（t=-0.109,P=0.913）;最大尿流率（Qmax）（18.8±5.2）ml/s,与小切口组（19.0±6.1）ml/s无统计学差异（t=-0.129,P=0.898）;术后残余尿（18.5±8.7）ml,与小切口组（19.3±7.8）ml无统计学差异（t=-0.340,P=0.735）。旋切组术后肛门通气时间（16.0±5.2）h,明显短于小切口组（27.5±6.7）h（t=-7.095,P=0.000）;术后住院时间（6.8±2.5）d,明显短于小切口组（8.6±2.8）d（t=-2.459,P=0.017）。结论经尿道腔内整体剜除联合耻骨上膀胱穿刺气膀胱下旋切治疗大体积BPH与前列腺剜除联合下腹膀胱小切口治疗效果相当,但恢复更快。Objective To investigate the feasibility and practicality of transurethral enucleation with pneumo-cystostomy rotary resection for large （more than 80 ml） benign prostatic hyperplasia （BPH）. Methods From November 2011 to May 2015, a total of 55 large BPH patients were divided into 2 groups according to time interval. The rotary resection group （35 cases,between June 2013 and May 2015） was given ransurethral enucleation of the hyperplastic glands of prostate. The resected gland was pushed into the bladder, and thereafter a bladder puncture was performed for pneumo-cystostomy rotary resection of BPH. The small incision group （20 cases, between November 2011 and May 2013） was given devided transurethral enucleative resection of the prostate. And the resected lesions were took out through a small incision of the lower abdomen. Results Satisfactory surgical results were obtained in all the cases. There were no significant differences between the rotary resection group and the small incision group in the operation time [（45.5 ±15.2） minvs. （43.8 ±13.4） min, t=0.416, P=0.679], the blood loss [（54.8 ±12.7） ml vs. （53.7 ±11.5） ml, t=0.319, P=0.751], the bladder irrigation time [（25.3±6.7） hvs. （26.8 ±7.0） h, t=0.786, P=0.435], theIPSS scores [（6.6±3.3） points vs. （6.7±3.2） points, t= -0.109, P=0.913], the Qmax [（18.8 ±5.2） ml/s vs. （19.0±6.1） ml/s, t= -0.129, P=0.898], and the postoperational residual urine volume [（18.5 ±8.7） mlvs. （19.3±7.8） ml, t= -0.340, P= 0. 735 ]. As compared to the small incision group, the rotary resection group had significant shorter postoperative flatus time [ （ 16.0 ± 5.2） hrs. （27.5±6.7） h, t= -7.095, P=0.000] and shorter postoperative hospitalization time [（6.8 ±2.5） d vs. （8.6 ±2.8） d, t = - 2. 459, P = 0. 017 ]. Conclusion Transurethral enucleation with pneumo-cystostomy rotary resection for large BPHhas almost the same effect with derided transurethral enucleative resection of prostate, but pa

关 键 词：前列腺增生症 整体剜除 气膀胱 小切口 

分 类 号：R699.8[医药卫生—泌尿科学]