三种不同腔内技术治疗高危重度前列腺增生的比较研究  

A comparative study of three different kinds of endourological treatment in aged and high risk benign prostatic hyperplasia patients

作　　者：张杰 龚旻[1] 朱汝健[1] 陈楚红[1] 伊庆同[1] 方恺[1] 王根旺[1] 

机构地区：[1]复旦大学附属浦东医院泌尿外科,上海201399

出　　处：《中国男科学杂志》2016年第12期26-31,共6页Chinese Journal of Andrology

基　　金：浦东新区卫生系统重点学科建设资助(PWZx2014-04);上海市浦东新区卫生系统学科带头人培养计划(PWRd2014-06)

摘　　要：目的比较经尿道2μm铥激光前列腺剜除术(TmLEP)、经尿道前列腺等离子剜除术(PKEP)及经尿道前列腺等离子切除术(PKRP)3种术式治疗高危重度前列腺增生的安全性和有效性。方法回顾性分析2014年1月至2016年1月在我院行手术治疗BPH的。患者152例,其中TmLEP组35例,PKEP组53例,PKRP组64例。对比各组手术患者手术时间、术中出血量、腺体切除量、术后并发症及疗效等。结果 TmLEP组、PKEP组和PKRP组手术时间分别为(64.3±15.9)min、(63.2±15.4)min和(80.1±24.3)min,TmLEP组及PKEP组较PKRP组手术时间明显短,差异具有统计学意义(P<0.05)。出血量TmLEP组、PKEP组和PKRP组分别为(26.3±6.2)mL、(27.4±6.1)m L和(60.4±10.2)mL,TmLEP组及PKEP组较PKRP组出血量明显少,差异具有统计学意义(P<0.05)。TmLEP组、PKEP组、PKRP组切除腺体质量分别为(50.9±6.6)g、(52.8±8.3)g和(32.9±6.3)g,TmLEP组及PKEP组较PKRP组切除腺体明显多,差异具有统计学意义(P<0.05)。术中TmLEP组、PKEP组、PKRP组出现包膜穿孔的例数分别为1例(2.9%)、1例(1.9%)和8例(12.5%)。PKEP组较PKRP组包膜穿孔率明显少,差异有统计学意义(P<0.05)。TmLEP组、PKEP组和PKRP组出现暂时性尿失禁的病例数分别为2例(5.7%)、2例(3.8%)、10例(15.6%)。PKEP组暂时性尿失禁发生率明显小于PKRP组,差异具有统计学意义(P<0.05)。术后1个月、6个月随访最大尿流率(Q_(max))、残余尿量(RUV)、国际前列腺症状评分(IPSS)、生活质量评分(QoL)等各项指标较术前均有较大改善,差异有统计学差异(P<0.05)。各组组内术后1个月与6个月之间差异无统计学意义(P>0.05)。各组组间术后1个月、术后6个月的各项指标在对应时间点比较也无统计学差异(P>0.05)。结论 TmLEP、PKEP及PKRP 3种术式均能有效缓解高危重度BPH的症状,但TmLEP及PKEP较PKRP手术时间短、术中出血少、腺体切除多、并发症少。加强围手术期的处理和个体化手术方案的选�Objective To explore the safety and efficacy of TmLEP, PKEP and PKRP in the treatment of aged and high risk benign prostatic hyperplasia patients. Methods Clinical data of 152 aged patients with high risk benign prostatic hyperplasia were analyzed retrospectively, including 35 for TmLEP treatment, 53 for PKEP treatment and 64 for PKRP treatment. The operation time, the amount of blood loss, the amount of gland resection and complications were compared among three groups. Results Operation times of TmLEP group and PKEP group were all shorter than that of PKRP group, respectively. [（64.3±15.9） min vs（80.1±24.3） min, P〈 0.05;（63.2±15.4） min vs（80.1±24.3） min, P〈 0.05]. The amount of blood loss of TmLEP group and PKEP group was less than that of PKRP group, respectively. [（26.3±6.2） mL vs（60.4±10.2）mL, P〈 0.05;（27.4±6.1） mL vs（60.4±10.2）mL, P〈 0.05]. The amounts of gland resection of TmLEP group and PKEP group were all more than that of PKRP group. [（50.9±6.6）g vs（32.9±6.3）g, P〈 0.05;（52.8±8.3）g vs（32.9±6.3）g, P〈 0.05]. The rate of prostate coated perforation in PKEP group was lower than that in PKRP group（1.9% vs 12.5%, P =0.032）. The urinary incontinence rate in PKEP group was lower than that in PKRP group（3.8% vs 15.6%, P =0.035）. There were significant improvements in indexes such as Q_（max）, RUV, IPSS and QoL in either the first or the sixth moth after the operation（P0.05）. But there were no significant differences in these indexes between the 1 and 6 moths＇ time from surgeries among three groups（P〉0.05） and there were no significant differences in these indexes in either 1 or 6 months＇ time from surgeries among three groups, presenting similar effects. Conclusion TmLEP, PKEP and PKRP are all effective in the treatment of aged and high risk benign prostatic hyperplasia patients. However, TmLEP and PKEP are more suitable because of shorter operation time, less blood loss, more amount of gland resection and less compl

关 键 词：激光 前列腺增生 经尿道前列腺切除术 

分 类 号：R699.8[医药卫生—泌尿科学]