经尿道整体剜除与经尿道前列腺切除术治疗大体积前列腺增生的比较分析

Comparison between transurethral enucleation plus opreative rotating cutter and transurethral prostatic resection for large benign prostatic hyperplasia

摘要:

目的??探讨经尿道剜除联合手术刨削器治疗大体积（>80 ml）前列腺增生症（BPH）的临床效果。方法?回顾性分析2014年2月-2016年2月65例大体积BPH，按手术方法分为两组，剜除组和电切组，剜除组30例，采用经尿道腔内整体剜除前列腺，完整剜除后推入膀胱，更换手术刨削器，将剜除的腺体粉碎取出；电切组35例，采用常规经尿道前列腺等离子电切术（TURP）。结果?65例均顺利完成手术。剜除组手术时间较TURP组短[（48.5±17.3）vs（75.6±21.4）min，t =5.55，P =0.000]，术中出血量较TURP组少[（51.8±14.6） vs （102.3±32.4）ml，t =7.87，P =0.000]。腺体切除体积较TURP组多[（78.3±15.5） vs （61.8±12.9）ml，t =4.69，P =0.000]。两组术后膀胱冲洗时间和术后住院天数相比较，差异无统计学意义（P >0.05）。剜除组术后暂时性尿失禁比例高于电切组（8/30 vs 4/35）。两组术后3个月国际前列腺症状评分（IPSS）、最大尿流率（Qmax）和残余尿均较术前明显改善（P <0.05），但两组间差异无统计学意义（P >0.05）。结论?经尿道腔内整体剜除联合手术刨削器治疗大体积BPH，手术时间更短，术中出血量少，切除腺体更彻底。

关键词:前列腺增生症;大体积;整体剜除;手术刨削器

Abstract:

Objective?To investigate the feasibility, effectiveness and practicality of transurethral enucleation plus opreative rotating cutter for large size benign prostatic hyperplasia (BPH).?Methods?65 large BPH patients were divided into 2 groups randomly from February 2014 to February 2016. One group, 30 cases, patients were performed rotating cutter operation: conducted ransurethral enucleation the hyperplastic glands of prostate and pushed into the bladder, and thereafter operative rotating cutter were used to comminute and aspirate the enucleated tissue. The other group, 35 cases, patients were performed conventional TURP.?Results?Satisfactory surgical results were obtained in all cases. Time of rotating cutter operation was shorter than TURP operation (48.5 ± 17.3) min vs (75.6 ± 21.4) min, t = 5.55, P = 0.000; Blood loss of rotating cutter operation was less than TURP operation (51.8 ± 14.6) ml vs (102.3 ± 32.4) ml, t = 7.87, P = 0.000. The volume of resected tissues of rotating cutter operation was more than TURP operation (78.3 ± 15.5) ml vs (61.8 ± 12.9) ml, t = 4.69, P = 0.000. Postoperative IPSS, Qmax, Residual urine between the two groups have no significant difference (P > 0.05). Postoperative indexs of these were significant different compared with preoperative ones (P < 0.05).?Conclusion?Transurethral enucleation plus opreative rotating cutter for large BPH take the shorter operative time and has less blood loss but more volume of resected tissues than TURP.

Key words:benign prostatic hyperplasia (BPH); large size; transurethral enucleation; opreative rotating cutter