经尿道前列腺等离子电切术与传统电切术治疗前列腺增生的疗效比较

Comparison of efficacy and safety between transurethral plasma kinetic resection of prostate and conventional transurethral resection of prostate for treatment of benign prostate hyperplasia

关键词:  经尿道前列腺等离子切除术  经尿道前列腺电切术  良性前列腺增生

Key words:  transurethral plasma kinetic resection of prostate  transurethral resection of prostate  benign prostate hyperplasia  therapeutic effect

摘要:

目的比较经尿道前列腺等离子切除术（transurethral plasma kinetic resection of prostate,PKRP）与经尿道前列腺电切术（transurethral resection of prostate,TURP）治疗前列腺增生（benign prostate hyperplasia,BPH）的疗效及安全性。方法按照知情同意及自主选择原则,收集符合入选标准684例,分为PKRP组和TURP组,每组各342例,比较两组手术前及手术后3个月国际前列腺症状评分（international prostate symptom score,IPSS评分）、最大尿流率(Q_max)、残余尿量（post-void urine volume,PVR）,比较两组手术后血红蛋白下降程度、血清钠变化程度、导尿管留置时间及手术并发症的发生率,并进行统计学分析。结果两组患者年龄、前列腺重量、术前IPSS评分、Q_max、PVR、血红蛋白水平、血清钠水平、住院时间、前列腺切除比例差异无统计学意义（P>0.05）。每组患者手术前后的IPSS评分、Qmax、PVR差异均有统计学意义（P<0.05）。PKRP组术后血红蛋白下降值、血清钠下降值低于TURP组,术后导尿管留置时间短于TURP组,术后出血发生率小于TURP组,前列腺电切综合征（transurethral resection syndrome,TURS）发生率低于TURP组,术中闭孔神经反射发生率PKRP组低于TURP组（均P<0.05）。两组术后感染、尿道狭窄发生率差异无统计学意义（P>0.05）。结论PKRP治疗BPH与TURP疗效相近,但手术并发症发生率低,是一种安全有效的BPH手术方式。

Abstract:

Objective To compare the efficacy and safety between transurethral plasma kinetic loop resection of prostate （PKRP） and conventional transurethral resection of prostate （TURP） for treatment of benign prostate hyperplasia （BPH）. Methods Total 684 BPH patients with indication for surgery were assigned to receive PKRP or TURP according to their own will with 342 cases in each group. The International Prostate Symptom Score （IPSS）, the maximum flow rate of urine （Qmax）, post-void urinevolume （PVR）, decline in serum sodium and hemoglobin were compared before and after operation in PKRP and TURP groups. The weight of resected prostatic chips, duration of catheterization and length of hospital stay were compared between two groups. Complications of each group were also recorded after three months of operation. Results There were no significant differences in age, weight of prostate, IPSS, Qmax, PVR, hemoglobin and serum sodium before operation between TURP and PKRP groups. There were no differences in post-operation infections, urethral stricture and length of hospital stay between two groups,but the PKRP group had a less decline in hemoglobin than TURP group （7 g/L vs 17 g/L, P＜0.05）, a lower reduction in serum sodium levels （2 mmol/L vs 5 mmol/L, P＜0.05）, a shorter catheterization time （82 h vs 96 h, P＜0.05）. Transurethral resection syndrome （TURS ） occurred in 1 case of PKRP group, but 14 cases in TURP group （P＜0.05）. The rate of obturator foramen reflex in PKRP group was lower than that in TURP group （1/342 vs 11/342, Χ²=8.48, P＜0.05） ; the rates of post-operation bleeding in PKRP group was lower than that in TURP group （5/342 vs 20/342, Χ²=9.34, P＜0.05）. Conclusion Compared to conventional TURP, PKRP has a similar efficacy but less complications for treatment of BPH.