小口径等离子电切镜下经尿道前列腺等离子电切术治疗良性前列腺增生合并轻度尿道狭窄的效果  

Efficacy of transurethral plasmakinetic resection of the prostate using a small-caliber resectoscope for benign prostatic hyperplasia with mild urethral stricture

作　　者：朱致维 卿智彪 何俊桓 伍学成 袁武雄[1] 段燚星[1] 李远伟[1] 曾铭强 ZHU Zhiwei;QING Zhibiao;HE Junhuan;WU Xuecheng;YUAN Wuxiong;DUAN Yixing;LI Yuanwei;ZENG Mingqiang(Department of Urology,Hunan Provincial People’s Hospital,Changsha 410005;Lower Urinary Tract and Pelvic Floor Function Disease Research Center of Hunan Institute of Geriatrics,Changsha 410005,China)

机构地区：[1]湖南省人民医院泌尿外科,长沙410005 [2]湖南省老年医学研究所下尿路及盆底功能疾病研究中心,长沙410005

出　　处：《中南大学学报(医学版)》2024年第11期1751-1756,共6页Journal of Central South University :Medical Science

基　　金：湖南省教育厅优秀青年项目(20B382)。

摘　　要：目的:传统的Fr26规格电切镜在治疗合并尿道狭窄的良性前列腺增生(benign prostatic hyperplasia,BPH)患者中难以使用。本研究采用尿道扩张联合小口径(Fr18.5)等离子电切镜治疗BPH合并轻度尿道狭窄患者,并评估其安全性和有效性。方法:回顾性分析2023年1至12月湖南省人民医院泌尿外科收治的37例BPH合并轻度尿道狭窄患者的临床资料,均采用小口径等离子电切镜行经尿道前列腺等离子电切术(plasmakinetic resection of theprostate,PKRP),术后常规留置Fr20三腔硅胶导尿管行持续性膀胱冲洗。比较患者手术前与手术后国际前列腺症状评分(International Prostate Symptom Score,IPSS)、最大尿流率(maximum flow rate,Q_(max))、膀胱残余尿量(post-voidingresidual urine volume,PVR)、生活质量(Quality of Life,QOL)评分的变化,并记录围手术期相关指标(术中出血量、手术时间、术后导尿管留置时间、术后住院时间)及并发症发生情况。结果:37例患者年龄中位数为69岁,排尿困难病史中位数为36个月;总前列腺特异性抗原(total prostate specific antigen,T-PSA)中位数水平为2.095 ng/mL,游离前列腺特异性抗原(free prostate specific antigen,F-PSA)中位数水平为0.561 ng/mL,F-PSA与T-PSA比值(F/T)中位数为0.3;超声测量前列腺最大径中位数为48 mm,前列腺体积(prostate volume,PV)中位数为41 mL。37例患者均成功完成手术,其中尿道外口狭窄11例,前尿道轻度狭窄19例,后尿道轻度狭窄7例(其中1例伴尿道膜部旁假性盲道长约1 cm)。手术时间(2.4±0.7)h,术中出血量(40±29)mL,术后留置导尿管时间中位数7 d,术后住院时间中位数7 d。37例患者术后均未发生尿失禁、反复血尿、脓毒血症等并发症,患者对手术效果满意。随访3~6个月,患者手术后IPSS、Q_(max)、PVR及QOL等指标较手术前改善,差异均有统计学意义(均P<0.01),且未观察到尿道狭窄进展及新发尿道狭窄等现象。结论:小口径等�Objective:The conventional Fr26 resectoscope is difficult to use in patients with benign prostatic hyperplasia(BPH)complicated by urethral stricture.This study aims to evaluate the safety and efficacy of transurethral plasmakinetic resection of the prostate(PKRP)using a small-caliber(Fr18.5)plasmakinetic resectoscope combined with urethral dilation in patients with BPH and mild urethral stricture.Methods:A retrospective analysis was conducted on 37 patients with BPH and mild urethral stricture treated at the Department of Urology,Hunan Provincial People’s Hospital from January 2023 to December 2023.All patients underwent PKRP with a small-caliber plasmakinetic resectoscope,followed by routine placement of a Fr20 three-way Foley catheter for continuous bladder irrigation.International Prostate Symptom Score(IPSS),maximum urinary flow rate(Q_(max)),post-voiding residual urine volume(PVR),and Quality of Life(QOL)scores were compared before and after surgery.Perioperative indicators(intraoperative bleeding,operative time,postoperative catheterization time,and postoperative hospital stay)and complications were recorded.Results:The median age was 69 years,and the median duration of voiding difficulty was 36 months.Median total prostate specific antigen(T-PSA)was 2.095 ng/mL,free prostate specific antigen(F-PSA)0.561 ng/mL,and F/T ratio 0.3.Median prostate diameter was 48 mm and volume 41 mL.All 37 surgeries were completed successfully:11 had external meatal stricture,19 had mild anterior urethral stricture,and 7 had mild posterior urethral stricture(1 patient with a 1 cm pseudo-blind tract near the membranous urethral).Operative time was(2.4±0.7)hours,blood loss was(40±29)mL,median catheterization duration was 7 days,and median hospital stay was 7 days.No cases of postoperative urinary incontinence,recurrent hematuria,or sepsis occurred,and patients were satisfied with the surgical outcome.At 3 to 6 months follow-up,IPSS,Q_(max),PVR,and QOL scores significantly improved compared to preoperative levels(all P<0.01),w

关 键 词：良性前列腺增生 等离子电切镜 经尿道前列腺等离子电切术 尿道狭窄 小口径 

分 类 号：R69[医药卫生—泌尿科学]