尿道双极等离子切割术与汽化切割术治疗前列腺增生疗效评价

目的:评价经尿道汽化电切(TUVP)与等离子体双极电切(PKRP)治疗前列腺增生的安全性和并发症。方法:应用WOLF及CIRCONACMIF汽化电切镜经尿道汽化电切469例,用英国GyrusMedical等离子双极电切镜等离子体双极点切313例。随访6￣36个月。结果:等离子体双极点切组国际症状评分(I-PSS)由平均26.3降至6.9,最大尿流率(Qmax)由7.9ml/s升至16.4ml/s,残余尿量(RUV)由124.6ml减至18.2ml,经尿道汽化电切组国际症状评分由25.6至8.9,最大尿流率由8.6ml/s到15.1ml/s,RUV由117.2ml减至21.3ml,3项指标差异无统计学意义(P>0.05)。等离子体双极点切组术中出血平均30ml,并发尿道外口狭窄4例(1.28%),无后尿道狭窄、尿失禁、继发性出血和经尿道切除综合征发生;经尿道汽化电切组术中平均出血70ml,并发后尿道狭窄6例(1.28%),尿失禁4例(0.85%),前尿道狭窄6例(1.28%),经尿道切除综合征5例(1.07%),继发性出血7例(1.49%)。结论:等离子体双极点切和经尿道汽化电切均是治疗前列腺增生微创有效的手术方式,临床症状改善疗效相同。等离子体双极点切出血更少,能有效减少并发症,其安全性和可操作性优于经尿道汽化电切。

An evaluation of transurethral double pole plasm electro-vaporization prostatectomy and electrovaporization prostatectomy for the treatment of benign prostatic hyperplasia

Objective:To evaluate the safety and the complication of transurethral double pole plasm eletro-vaporization prostatectomy and eletro-vaporization prostatectomy. Methods:Applying WOLF and CIRCONACMIF electrovaporization resecto-scope or British Gyrus Medical double pole plasm electro-vaporization resecto-scope treated 782 patients(aged 60-89years,mean age 74.5 years)with benign prostatic hyperplasia(BPH).Among the total,469 patients underwent electrovaporization and 313 patients underwent double pole plasm electro-vaporization.The range of follow-up period is 6-36 month.Results: In PKRP group,IPSS decreased from 26.3 to 6.9, Qmax increased from 7.9ml/s to 16.4ml/s,RUV decreased from 124.6ml to 18.2ml; in TUVP group, IPSS decreased from 25.6 to 8.9, Qmax increased from 8.6ml/s to 15.1ml/s, RUV decreased 117.2ml to 21.3ml. There was no statistical significance between two groups in the three data. In PKRP group, the average amount of bleeding is 30ml in operation,four patients had stricture at the external urethral orifice(1.28%), and there was no posterior urethral stricture, incontinence of urine, secondary bleeding and TURS. In TUVP group, the average amount of bleeding is 70ml in operation,six patients had stricture at posterior urethra(1.28%),four patients had incontinence of urine(0.85%),six patients had stircture at anterior urethra(1.28%),five patients had TURS(1.07%),seven patients had secondary bleeding(1.49%).Conclusion:PKRP and TUVP both are effective and mini-mally invasive alternative therapies in managentment of benign prostatic hyperplasia. Two modalities are alike in the improvement of clinical symptoms. PKRP is less in bleeding, effective in reducing complications and outsweighing in safety and handling than TUVP.