双极等离子经尿道前列腺剜切日间手术临床实践  

Feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate in day surgery mode

作　　者：邹志辉 张礼刚[1] 蔡可可 胡永涛 刘书琛 陈佳 葛秦涛 赵晓虎 郝宗耀[1] 梁朝朝[1] ZOU Zhihui;ZHANG Ligang;CAI Keke;HU Yongtao;LIU Shuchen;CHEN Jia;GE Qintao;ZHAO Xiaohu;HAO Zongyao;LIANG Chaozhao(Department of Urology,the First Affiliated Hospital of Anhui Medical University,Institute of Urology,Anhui Medical University,Anhui Provincial Key Laboratory of Genitourinary Diseases,Anhui Clinical Research Center of Urinary System Diseases,Hefei 230022,China;The First Clinical Medical College,Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科安徽医科大学泌尿外科研究所泌尿生殖系统疾病安徽省重点实验室安徽省泌尿系统疾病临床医学研究中心,安徽合肥230022 [2]安徽医科大学第一临床医学院,安徽合肥230022

出　　处：《浙江大学学报（医学版）》2023年第2期148-155,共8页Journal of Zhejiang University(Medical Sciences)

基　　金：国家临床重点专科建设项目(2011299);安徽省第六批卫生健康适宜技术推广项目(SYJS202110);安徽医科大学校科研基金(2020xkj189,2021xkj157);安徽医科大学第一附属医院临床研究项目(PJ2018-13-23)。

摘　　要：目的:探讨双极等离子经尿道前列腺剜切术(B-TUERP)日间手术模式治疗良性前列腺增生(BPH)患者的安全性和可行性。方法:分析2021年1月至2022年8月在安徽医科大学第一附属医院日间手术病房接受B-TUERP的34例BPH患者的临床资料。患者在预住院期间完成术前筛查及麻醉评估,入院当天即安排手术,手术由同一医生完成,手术遵循解剖性前列腺剜除及“绝对控血”标准。术后第1天停膀胱冲洗、拔除导尿管并进行出院评估。记录患者的一般资料、围手术期结果、随访结果及住院费用等。结果:所有手术均成功,患者平均年龄(62.2±7.8)岁,前列腺体积(50.2±29.3)mL,手术时间(36.5±19.1)min,血红蛋白下降(16.2±7.1)g/L,血钠下降(2.2±2.0)mmol/L,术后住院时间(17.7±2.2)h,总住院时间(20.8±2.1)h,住院费用(13558±2320)元。除中转普通病房1例外,其余33例均术后首日出院,其中3例带导尿管出院。患者术后3个月国际前列腺症状评分、生活质量评分、最大尿流率等均较术前明显改善(均P<0.01)。34例患者中,发生暂时性尿失禁3例、尿路感染1例、尿道狭窄4例、膀胱颈挛缩2例,无其他Clavien 2级以上并发症发生。结论:在手术技术熟练及选择合适BPH患者条件下,B-TUERP日间手术是一种安全、可行、经济、高效的治疗模式,可以在有条件的医院推广。Objective:To evaluate the feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate(B-TUERP) in day surgery.Methods:From January 2021 to August 2022,34 patients with benign prostatic hyperplasia(BPH) underwent B-TUERP in day surgery in the First Affiliated Hospital of Anhui Medical University.Patients completed the screening and anesthesia evaluation before admission and received the standard surgery which implements “anatomical enucleation of the prostate” and “absolute bleeding control” on the same day of admission,and by the same doctor.Bladder irrigation was stopped,catheter was removed and the discharge evaluation was performed on the first day after operation.The baseline data,perioperative conditions,time of recovery,treatment outcomes,hospitalization costs,and postoperative complications were analyzed.Results:All operations were successfully conducted.The average age of the patients was(62.2±7.8) years,average prostate volume was(50.2±29.3) mL.The average operation time was(36.5±19.1) min,the average hemoglobin and blood sodium were decreased by(16.2±7.1) g/L and(2.2±2.0) mmol/L,respectively.The average postoperative length of hospital stay,and total length of hospital stay were(17.7±2.2) and(20.8±2.1) h,respectively,and the average hospitalization cost was(13 558±2320) CNY.All patients were discharged on the day after surgery except for one patient who was transferred to a general ward.Three patients received indwelling catheterization after catheter removal.The 3-month follow-up results showed a substantial improvement in the International Prostate Symptom Score,quality of life score and maximum urinary flow rate(all P<0.01).Three patients experienced temporary urinary incontinence,1 patient experienced urinary tract infection,4 patients were diagnosed with urethral stricture and 2 patients experienced bladder neck contracture.No complications above Clavien grade Ⅱ occurred.Conclusion:The preliminary results showed that B-TUERP ambulatory s

关 键 词：良性前列腺增生 经尿道手术 前列腺剜除术 双极等离子 日间手术 

分 类 号：R697.32[医药卫生—泌尿科学]