前列腺大小对经尿道等离子剜除治疗良性前列腺增生疗效和手术并发症的影响  

Plasmakinetic enucleation of the prostate： the complication and outcome according to the prostate size

作　　者：饶建明[1] 任毅馨[1] 何江[1] 杨精华[1] 丁平[1] 

机构地区：[1]湖南省第二人民医院泌尿外科,长沙410007

出　　处：《中国医师杂志》2016年第4期557-561,共5页Journal of Chinese Physician

摘　　要：目的 评估前列腺大小对经尿道等离子剜除（PKEP）治疗良性前列腺增生（BPH）的疗效和手术并发症的影响.方法 回顾性分析采用PKEP治疗BPH患者326例临床资料.依据经直肠B超测量的前列腺体积,将患者分为三组：前列腺体积＜ 40 ml组（A组）92例、前列腺体积40～80 ml组（B组）155例和前列腺体积＞80 ml组（C组）79例.监测并记录手术前、后血清钠和血红蛋白的减少量、手术时间、前列腺切除重量、术后膀胱冲洗时间、导尿管留置时间、住院时间及手术并发症.观察术前和术后1、3、6、12个月时的国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）和残余尿量（PVR）变化情况.结果 3组间手术时间和前列腺切除重量比较差异均有统计学意义（P＜0.01）.但剜除效率是随着前列腺体积增大而显著提高（P＜0.01）.3组间手术前后血红蛋白下降量、血清钠离子下降量、术后膀胱冲洗时间、导尿管留置时间和住院时间比较差异均无统计学意义（P＞0.05）.术后1、3、6、12个月随访,3组IPSS、QOL、Qmax、PVR较自身术前显著改善（P＜0.01）,组间比较差异无统计学意义（P＞0.05）.围手术期和术后并发症没有随前列腺体积增大而显著增加（P＞0.05）.结论 尽管大体积前列腺增生患者PKEP手术时间显著增加,但前列腺大小并不影响PKEP围手术期和术后并发症发生及排尿症状的改善.Objective To evaluate surgical complications and outcomes based on prostate size in patients with benign prostatic hyperplasia （BPH） treated with plasmakinetic enucleation of prostate （PKEP）.Methods A retrospective review was conducted of PKEP performed in 326 patients with BPH.According to the prostate size on preoperative transrectal ultrasonography measurement,patients were divided into three groups：groupl：〈40ml （n =92）,group2：40～80ml （n =155）,and group3：〉80ml （n =79）.Intraoperative and perioperative parameters were evaluated.Patient perioperative data and postoperative outcomes were compared.Patients were followed up at 1,3,6 and 12 months after surgery.Early and late complications were recorded.Results There were significant differences among three groups regarding the mean operative time （P 〈 0.01） and the mean resected tissue weight （P 〈 0.01）.However,enucleation efficiency （P 〈 0.01） in gm tissue per minute increased significantly as prostate size increased.Mean hemoglobin decrease （P 〉0.05）,mean serum sodium decrease （P 〉0.05）,mean postoperative irrigation time （P 〉 0.05）,mean catheter time （P 〉 0.05） and mean hospital stay （P 〉0.05） did not differ significantly among three groups.Three groups had a similar and significant postoperative improvement in international prostate symptom score （IPSS）,quality of life （QOL）,maximum urine rate （Qmax）,and post-void residual urine volume（PVR） independent of prostate size （P 〈 0.01）,but no significant difference was found among three groups during 1,3,6 and 12-month follow-up （P 〉 0.05）.Perioperative and postoperative complications did not depend on prostate size （P 〉 0.05）.Conchsions Although patients with a larger BPH required significantly longer operation time in PKEP,prostate size did not affect perioperative and postoperative complications or micturition improvement.

关 键 词：前列腺 前列腺增生/外科学 经尿道前列腺切除术 

分 类 号：R699.8[医药卫生—泌尿科学]