完全保留“11-1点”尿道粘膜前列腺剜除对尿控和勃起功能的影响  

PKEP with complete preservation of the urethral mucosa in the 11-1 oclock position improves urinary continence and protects erectile function in BPH patients

作　　者：沈亚军 张书贤 章小毅 王允武 郑久德 柴雪 王建帮 王荣 SHEN Ya-jun;ZHANG Shu-xian;ZHANG Xiao-yi;WANG Yun-wu;ZHENG Jiu-de;CHAI Xue;WANG Jian-bang;WANG Rong(Department of Urology,The Second Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241001,China)

机构地区：[1]皖南医学院第二附属医院泌尿外科,安徽芜湖241001

出　　处：《中华男科学杂志》2023年第2期131-137,共7页National Journal of Andrology

基　　金：安徽省卫生健康委员会科研项目(AHWJ2021b122)。

摘　　要：目的:评估完全保留“11-1点”尿道粘膜等离子剜除术(PKEP)治疗良性前列腺增生(BPH)对患者尿控及勃起功能的影响。方法:回顾性分析2017年1月至2021年12月84例术前3月有性活动BPH患者的临床资料,早期(2017年1月至2020年12月)48例为传统PKEP组,采用精阜旁“5,7”点切开暴露外科包膜层面后整叶法剜除增生前列腺组织,2020年1月至2021年12月36例患者为改良PKEP组,采用完全保留“11-1”点尿道粘膜的PKEP术。比较两组患者围手术期一般资料及术后随访结果等指标。结果:84例患者均接受手术治疗并完成术后12个月随访。两组患者术前年龄、病程时间、前列腺体积、术前残余尿量(PVR)、术前最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、血清前列腺特异性抗原(PSA)、生活质量评分(QOL)和国际勃起功能评分(IIEF)等无统计学差异。两组患者手术时间、术中血红蛋白下降、切除组织体积、膀胱冲洗时间及术后住院时间等资料无显著差异。随访结果表明两组患者Qmax、IPSS均较术前有明显改善,改善程度两组间无显著差异,传统PKEP组和改良PKEP组术后1个月尿控率分别为43.25%(20/48)和66.67%(24/36),差异有统计学意义(P=0.025)。传统PKEP组和改良PKEP组术后6个月和12个月IIEF-5分别为(15.27±2.74)分vs(16.69±3.21)分(P=0.032),(16.96±2.54)分vs(18.04±2.04)分(P=0.039),逆行射精发生率为56.25%(28/48)vs 33.33%(12/36)(P=0.018),47.92%(23/48)vs 25%(9/36)(P=0.027),上述数据比较差异具有统计学意义。两组患者术后1、3、6、12个月QOL分别为(2.12±0.69)分vs(2.61±0.81)分(P=0.005),(1.94±0.51)分vs(2.24±0.66)分(P=0.026),(1.80±0.53)分vs(2.12±0.83)分(P=0.047),(1.72±0.58)分vs(1.94±0.65)分(P=0.038),具有显著性差异。结论:与传统的PKEP比较,完全保留“11-1”点尿道粘膜PKEP治疗BPH能够更好的保护尿控、勃起和射精功能,显著改善BPH患者术后的生活质量。Objective:To evaluate the efct of transurethral plasmakinetice enucleation of the prostate(PKEP)with complete preservation of the urethral mucosa in the 11-I oclock position on urinary continence and ereetile function in BPH patients.Methods:We retrospectively analyzed the clinical data on 84 cases of BPH treated by traditional PKEP(group A,n=48)or modified PKEP with complete preservation of the urethral mucosa in the 11-1 oclock position(group B,n=36)from January 2017 to December 2021.All the patients had sexual activities within three months preoperatively.We followed up the patients for 12 months after surgery and compared the baseline,surgery-related and follow-up data between the two groups of patients.Results:There were no statistically significant differences between the two groups of patients in age,disease duration,prostate volume,preoperative postvoid residual urine(PVR),preoperative maximum urinary flow rate(Qmax),IPSS,PSA level,QOL scores or IIEF-5 scores,nor in the operation time,intraoperative hemoglobin decrease,volume of resected tissue,bladder flushing time,postoperative hospital stay,or postoperative improvement of Qmax and IPSS.The rate of urinary continence was significantly higher in group B than in A at 1 month postoperatively(66.67%[24/36]us 43.25%[20/48],P=0.025)and so were IEF-5 scores at 6 months(16.69±3.21 us 15.27±2.74,P=0.032)and 12 months(18.04±2.04 us 16.96±2.54,P=0.039),while the incidence rate of retrograde ejaculation markedly lower in the former than in the latter group at 6 months(33.33%[12/36]us 56.25%[28/48],P=0.018)and 12 months(25%[9/36]us 47.92%[23/48],P=0.027).At 1,3,6 and 12 months after surgery,the patients in group B also showed remarkably higher Q0L scores than those in group B(2.61±0.81 us 2.12±0.69,P=0.005;2.24±0.66 us 1.94±0.51,P=0.026;2.12±0.83 us 1.80±0.53,P=0.047;and 1.94±0.65 us 1.72±0.58,P=0.038).CConclusion:Modified PKEP with complete preservation of the urethral mucosa in the 11-1 oclock position can improve urinary continence,protect erectile fu

关 键 词：经尿道前列腺等离子剜除术 良性前列腺增生 保留尿道 勃起功能 生活质量 

分 类 号：R699.8[医药卫生—泌尿科学]