分叶剜或切结合治疗高危、大体积前列腺增生的疗效观察  

作　　者：陈尧康[1] 傅晶[1] 虞利民[1] 黄正[1] 叶华建 王永军[1] 黄鸣文 

机构地区：[1]浙江省绍兴第二医院,312000

出　　处：《浙江临床医学》2021年第12期1784-1786,1789,共4页Zhejiang Clinical Medical Journal

摘　　要：目的探讨分叶剜或切结合治疗高危、大体积(>80 mL)前列腺增生(BPH)的安全性和有效性。方法123例高危、大体积BPH患者随机分为分叶剜或切结合组、电切组(TURP)和完全剜除组(TUEP),每组各41例。比较分析三组患者围手术期以及术后3个月随访的各项指标,如手术时间、血清钠下降水平、血红蛋白下降水平、前列腺切除重量、膀胱持续冲洗时间、留置尿管时间、尿失禁发生率,以及残余尿量(PVR)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)和生活质量评分(QOL)的改变情况等。结果分叶剜或切结合组的手术时间、血清钠下降水平、血红蛋白下降水平、前列腺切除重量、膀胱持续冲洗时间以及留置尿管时间与电切组比较,差异均有统计学意义(P<0.05)。分叶剜或切结合组无输血病例,明显低于电切组(P<0.05)。术后拔除尿管后24 h尿失禁发生率(14.6%)与电切组相当(P>0.05),但明显低于完全剜除组(P<0.05)。三组患者术后3个月的PVR、Qmax、IPSS和QOL与术前比较,差异均有统计学意义(P<0.05)。分叶剜或切结合组患者术后Qmax为(21.8±3.0)mL/s,明显优于电切组(19.4±2.8)mL/s,差异有统计学意义(P<0.05),与完全剜除组无明显差异(P>0.05)。术后PVR、IPSS和QOL的比较,分叶剜或切结合组与电切组、完全剜除组的差异均无统计学意义(P>0.05)。三组患者均未出现永久性尿失禁。结论分叶剜或切结合治疗高危、大体积(>80mL)BPH的安全性高、疗效好、恢复快、并发症少,且暂时性尿失禁发生率低。Objective To evaluate the safety and efficacy of the divided lobectomy of high-risk and large volume(>80 mL)benign prostatic hyperplasia(BPH)by combined enucleation or resection.Methods 123 patients with a high-risk and large volume prostate were randomly divided into three groups,enucleation or resection group,resection group(TURP)and enucleation group(TUEP)with 41 patients in each group.The perioperative and 3-month follow-up indexes of the three groups were compared and analyzed,including operation time,serum sodium decline,hemoglobin decreased level,prostate weight,bladder continuous flushing time,indwelling catheter time,incidence of urinary incontinence,and changes in postvoid residual urine(PVR),maximum urinary flow rate(Qmax),international prostate symptom score(IPSS)and quality of life(QOL).Results The enucleation or resection group was significantly superior to the resection group in terms of the operation time,serum sodium decrease,hemoglobin decrease,the weight of the resected prostate,bladder irrigation duration,and catheter indwelling time(P<0.05).There were no blood transfusion cases in the combined group,which was significantly lower than that in the resection group(P<0.05).The incidence of urinary incontinence was similar between the two groups at 24 hours after catheter removal,but the incidence of urinary incontinence in the enucleation or resection group(14.6%)was significantly lower than that in the enucleation group(P<0.05).At 3 months postoperatively,there were significant differences in PVR,OMAX,IPSS,and QOL before and after operation of the three groups respectively(P<0.05).The postoperative Qmax of enucleation or resection group was(21.8±3.0)mL/s,which was significantly better than that of the resection group(19.4±2.8)mL/s(P<O.OS),and there was no significant difference between the enucleation or resection group and the enucleation group(P<0.05).There was no significant difference in PVR,IPSS and QOL compared with the two control groups(P>0.05).There was no permanent urinary incontinen

关 键 词：高危前列腺增生 大体积前列腺增生 经尿道前列腺剜除术 经尿道前列腺电切术 尿失禁 

分 类 号：R69[医药卫生—泌尿科学]