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经尿道“悬挂式”前列腺剜切术治疗良性前列腺增生
Novel transurethral “suspension type” enucleation resection of prostate for benign prostatic hyperplasia(report of 148 cases)
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DOI:
作者:
郑军华
Junhua-Zheng
作者单位:
上海市第十人民医院
Department of Urology, Shanghai tenth people’s hospital, Tongji University School of Medicine
关键词:
前列腺增生;悬挂式剜除术;并发症;安全性
Benign prostatic hyperplasia; suspended type; enucleation; complications; safety
摘要:
目的 分析经尿道“悬挂式”前列腺剜切术治疗良性前列腺增生的疗效及安全性。 方法 回顾分析2014年7月至2015年5月在我院行经尿道“悬挂式”前列腺剜切术的148例前列腺增生患者,统计手术时间、留置尿管时间、膀胱持续冲洗时间、住院天数、手术并发症、血红蛋白下降量、生活质量评分(QOL)(术前和术后1月、3月和6月)、IPSS评分(术前和术后1月、3月和6月)、和最大尿流率(Qmax)(术前和术后1月、3月和6月)。结果 手术均顺利完成,平均手术时间(31.4±16.2)min,平均膀胱持续冲洗时间(17.3±6.3)h,平均留置尿管时间(2.1±0.3)d,平均住院天数(3.3±1.6)d。平均血红蛋白下降量为(3.7±1.8)g/L,无输血病例。术前、术后1月、术后3月和术后6月的Qmax分别是(7.13±3.45 vs 21.17±5.46 vs 23.68±5.28 vs 23.47±6.12)ml/s,术前、术后1月、术后3月和术后6月的IPSS评分分别(18.31±5.61 vs 9.67±4.63 vs 8.52±4.34 vs 7.03±2.87)、术前、术后1月、术后3月和术后6月的QOL评分(4.18±1.31 vs 2.13±1.06 vs 1.51±0.82 vs 1.19±0.51),术后各项指标较术前均有明显改善,差别有统计学意义(p<0.05)。36例(24.3%)患者出现暂时性尿失禁,经提肛锻炼等康复治疗后尿控恢复正常 。随访期间,无大出血、膀胱穿孔、直肠损伤、尿道狭窄、永久性尿失禁等严重手术并发症发生。结论 经尿道“悬挂式”前列腺剜切术治疗良性前列腺增生具有术中出血少、手术视野清晰、腺体切除多、安全易操作、疗效佳,可以在临床广泛应用和推广。
Objective To investigate the curative effects and safety of transurethral “suspended type” enucleation resection for benign prostatic hyperplasia (BPH). Methods From July 2014 to March 2015, a total of 148 consecutive patients treated with transurethral “suspended type” enucleation resection for benign prostatic hyperplasia were enrolled in this study. Clinical data including the operation time, catheter time, bladder continuous irrigation time, hemoglobin decrease and perioperative complications was collected. Besides, the maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), and quality of life (QOL) before operation and postoperative 1, 3 and 6 m were recorded. Results All operations were successfully performed. The average operation time, bladder continuous irrigation time, catheter time and stay in hospital was (31.4±16.2) min, (17.3±6.3) h, (2.1±0.3) d and (3.3±1.6) d respectively. The mean hemoglobin decrease was (3.7±1.8) g/L, and no case received blood transfusion. Before operation and postoperative 1, 3 and 6 m, Qmax, IPSS and QOL were (7.13±3.45 vs 21.17±5.46 vs 23.68±5.28 vs 23.47±6.12) ml/s, (18.31±5.61 vs 9.67±4.63 vs 8.52±4.34 vs 7.03±2.87) and (4.18±1.31 vs 2.13±1.06 vs 1.51±0.82 vs 1.19±0.51). Postoperative Qmax, IPSS and QOL were significantly better compared with preoperative data (p<0.05). Transient urinary incontinence was observed in 36 (24.3%) patients, and symptoms obviously relieved after 1 m rehabilitation therapy. Within the follow-up period, no case with urethral stricture, severe hemorrhage, bladder perforation, rectal injury, urethral stricture, permanent incontinence and other severe complications were found. Conclusion Transurethral “suspended type” enucleation resection for benign prostatic hyperplasia had many advantages such as less bleeding, clearer surgical field, higher gland resection rate and better curative effects, and thus it should be widely used in clinical practice.
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