经尿道等离子前列腺剜除术和经尿道等离子前列腺切除术治疗良性前列腺增生的临床疗效比较

doi:10.13481/j.1671-587X.20230531

摘要/Abstract

摘要：

目的比较经尿道等离子前列腺剜除术（PKEP）和经尿道等离子前列腺切除术（PKRP）2种术式治疗良性前列腺增生（BPH）的临床疗效，为BPH的治疗方式选择提供依据。方法收集60例因下尿路症状（LUTS）就诊且门诊初诊为BPH的患者的临床资料，在患者知情同意的情况下将患者随机分为PKEP组（采用PKEP进行治疗）和PKRP组（采用PKRP进行治疗），每组各30例。观察2组患者术前年龄、体质量、体质量指数（BMI）、总前列腺特异抗原（tPSA）水平、红细胞比容（HCT）、血红蛋白（Hb）水平、术前和术后钠离子水平、前列腺体积、中叶突入程度、并发症（高血压、糖尿病和呼吸系统疾病）发生率和口服5α还原酶抑制剂百分率，手术时间、术中出血量、切除组织体积、切除速率、切除效率，术后总住院时间、留置尿管时间、膀胱冲洗时间、术前和术后生活质量（QOL）评分及国际前列腺症状评分（IPSS），并比较2组患者术后不良反应发生情况。结果 2组患者术前年龄、体质量、BMI、tPSA水平、术前HCT、术前Hb水平、术前钠离子水平、前列腺体积和中叶突入程度比较差异无统计学意义（P>0.05）；2组患者并发症（高血压、糖尿病和呼吸系统疾病）发生率和口服5α还原酶抑制剂百分率比较差异无统计学意义（P>0.05）；PKRP组患者术中出血量、切除组织体积、切除速率和切除效率高于PKRP组（P<0.05）；2组患者总住院时间、术后留置尿管时间和术后膀胱冲洗时间比较差异无统计学意义（P>0.05）；2组患者术前和术后钠离子水平、QOL评分和IPSS评分比较差异无统计学意义（P>0.05）；2组患者术前和术后各自组内QOL评分及IPSS评分比较差异有统计学意义（P<0.05）；PKEP组患者出现尿失禁1例，PKRP组患者出现尿失禁2例，未出现其他手术相关并发症。结论 2种术式疗效和安全性相似，均可获得满意的手术效果； PKEP术中患者出血量较少，腺体切除量、切除效率和切除速率较高，是治疗BPH的较好方法。

关键词: 良性前列腺增生, 经尿道等离子前列腺剜除术, 经尿道等离子前列腺切除术, 切除速率, 切除效率

Abstract:

Objective To compare the clinical efficacies of transurethral plasmakinetic enucleation of prostate （PKEP） and transurethral plasmakinetic resection of prostate （PKRP） in the treatment of benign prostatic hyperplasia （BPH）， and provide the evidence for the treatment options for BPH. Methods The clincal data of 60 patients with lower urinary tract symptoms （LUTS） and initial diagnosis as BPH were collected. With the patients’ informed consent， they were divided into PKEP group （treated with PKEP） and PKRP group（treated with PKRP）， and there were 30 cases in each group. The age， body weight， body mass index （BMI）， total prostate-specific antigen （tPSA） level， hematocrit （HCT）， hemoglobin （Hb） level，preoperative and postoperative sodium ion level， prostate volume，degree of midlobe median lobe protrusion， occurrence of complications （hypertension， diabetes， and respiratory diseases）， percentage of oral 5α-reductase inhibitor using， operation time，amount of intraoperative blood， resected tissue volume， resection rate，resection efficiency，total hospital stay after operation，indwelling catheterization time， bladder irrigation duration， sodium ion level，Quality Of Life （QOL） score， and International Prostate Symptom Score （IPSS） before and after operation of the patients in two groups were observed and compared.The incidences of adverse reactions of the patients in two groups after operation were also compared. Results There were no significant differences in age， body weight， BMI，tPSA level， preoperative HCT， preoperative Hb level，sodium ion level before operation， prostate volume， and degree of midlobe protrusion of the patients between two groups （P>0.05）. There were no statistically significant differences in the occurrences of complications （hypertension， diabetes， and respiratory diseases） and the percentage of oral 5α-reductase inhibitor using of the patients between two groups （P>0.05）； the amount of blood during operation， resected tissue volume， resection rate， and resection efficiency of the patients in PKRP group were higher than those in PKEP group （P<0.05）； there were no significant differences in the total hospital stay，indwelling catheterization time， and bladder irrigation duration after operation of the patients between two groups （P>0.05）； there were no significant differences in the sodium ion levels， QOL scores， and IPSS of the patients between two groups before and after operation（P>0.05）； there were significant differences in the QOL scores and IPSS of the patients in each group before and after operation （P<0.05）.There was one case of urinary incontinence in PKEP group and two cases of urinary incontinence in PKRP group， without other operation-related complications. Conclusion Both two methods have similar efficacy and safety， and can achieve the satisfactory surgical outcomes.The patients undergoing PKEP have less amount of blood during operation， higher resected tissue volume，the higher resection efficiency， and higher resection rate， which is a better way to treat BPH.

Key words: Benign prostatic hyperplasia, Transurethral plasmakinetic enucleation of prostate, Transurethral plasmakinetic resection of prostate, Resection rate, Resection efficiency

中图分类号:

R699.6

任家祥,金光俊,王永刚. 经尿道等离子前列腺剜除术和经尿道等离子前列腺切除术治疗良性前列腺增生的临床疗效比较[J]. 吉林大学学报(医学版), 2023, 49(5): 1344-1350.

Jiaxiang REN,Guangjun JIN,Yonggang WANG. Comparison of clinical efficacies of transurethral plasmakinetic enucleation of prostate and transurethral plasmakinetic resection of prostate in treatment of benign prostatic hyperplasia[J]. Journal of Jilin University(Medicine Edition), 2023, 49(5): 1344-1350.

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