经尿道双极等离子体前列腺剜除术的并发症分析

【摘要】 目的 探讨经尿道双极等离子体前列腺剜除术(TUPKEP)治疗良性前列腺增生(BPH)的疗效。方法 对本院2009年3月~2012年4月收治的368例良性前列腺增生患者采用经尿道双极等离子体前列腺剜除术的临床资料进行回顾性分析。结果 368例患者手术均获完成。平均手术时间(55.1±19.2)min,术中平均出血量(88±26)mL,切除腺体平均重量(60.5±26.3)g,留置尿管时间(4.8±1.3)天,术后住院时间(5.9±1.8)天。并发症中,前列腺包膜穿孔4例,其中1例膀胱前列腺连接部穿孔行腹腔引流;12例术后拔除尿管后出现排尿困难,经重置尿管后缓解,轻度尿失禁38例,张力性尿失禁12例,无真性尿失禁发生;膀胱颈挛缩5例,输血6例,逆行射精86例,尿道狭窄10例,阴茎勃起功能障碍(ED)39例,无TUR综合征及再次手术病例。术后患者IPSS、QOL、RVR 、Qmax与术前比较差异有统计学意义(P<0.01)。结论 TUPKEP手术时间、术后留置尿管时间和住院时间较短,术中出血量、并发症少,是治疗前列腺增生的安全有效的方法,其并发症可控可防。

Analysis of complications of transurethral biploar plasma kinetic enucleation of prostate

Objective To investigate the clinical efficacy of transurethral bipolar plasma kinetic enucleation of prostate （TUPKEP） for the treatment of benign prostatic hyperplasia （BPH）. Methods The clinical data of 368 cases with BPH treated with TUPKEP were analyzed retrospectively. Results The operations were completed in all cases. The operation time was 55.1±19.2 min, the blood loss was 88±26 mL, the resected prostate tissues weight was 60.5±26.3 g, the catheter retention time was 4.8±1.3 days and the postoperative hospitalization time was 5.9±1.8 days. The perforetion of the prostatic capsule happened in four cases. Among them, 1 case occurred perforation in the bladder-prostate junction and the abdominal drainage was performed. Thirty-eight patients had mild urinary incontinence, 12 patients had stress incontinence. No permanence incontinence happened. Five cases had bladder neck contracture and six cases needed blood transfusion during operation. Eighty-six cases had retrograde ejaculation and 10 cases had urethral stenosis, 39 cases had erectile dysfunction （ED）. No TUR syndrome happened and no re-operation was performed in these cases. There were statistical significances of IPSS, QOL, PVR and Qmax between pre-operation and post-operation. Conclusion TUPKEP has advantages in operation time, bleeding, post-operative hospitalization time,the mean bladder irrigating time and few complications and it is an effective and safe therapy for BPH. Complications of TUPKEP are controllable and preventable.