【摘要】：良性前列腺增生(BPH)是引起中老年男性排尿障礙的常見(jiàn)病,TURP是目前公認(rèn)的手術(shù)治療BPH的“金標(biāo)準(zhǔn)”,特別是雙極等離子電切器的投入使用,其手術(shù)優(yōu)勢(shì)更明顯。經(jīng)尿道雙極等離子前列腺剜除術(shù)(TUERP)至今開(kāi)展已十余年,但這類病人的長(zhǎng)期療效如何,能否挑戰(zhàn)TURP術(shù)的“金標(biāo)準(zhǔn)”地位,目前尚未看到類似的報(bào)道。在本研究中我們以“金標(biāo)準(zhǔn)”的“經(jīng)尿道雙極等離子前列腺電切術(shù)(TURP)”為對(duì)照,開(kāi)展TUERP術(shù)與TURP術(shù)治療BPH術(shù)后10年長(zhǎng)期的隨診研究和短期的隨機(jī)對(duì)照研究,來(lái)綜合評(píng)價(jià)TUERP術(shù)治療前列腺增生的應(yīng)用效果,為T(mén)UERP術(shù)的進(jìn)一步推廣應(yīng)用提供理論依據(jù)。第一章經(jīng)尿道雙極等離子前列腺剜除術(shù)與經(jīng)尿道雙極等離子前列腺電切術(shù)治療良性前列腺增生的10年隨診研究目的為了客觀評(píng)價(jià)TUERP術(shù)后十年的長(zhǎng)期療效,以及復(fù)發(fā)等并發(fā)癥等情況。方法以TURP術(shù)為對(duì)照組,研究TUERP術(shù)患者術(shù)前、術(shù)后10年的前列腺體積(PV)、膀胱殘余尿量(PVR)、前列腺特異性抗原(PSA)、最大尿流率(Qmax)、國(guó)際前列腺癥狀評(píng)分(IPSS)、生活質(zhì)量指數(shù)評(píng)分(QOL)以及術(shù)后十年內(nèi)并發(fā)癥的發(fā)生情況。結(jié)果TUERP 組術(shù)后 10 年的 PV、PSA、IPSS、QOL 值均小于 TURP 組,TUERP組術(shù)后10年的Qmax值大于TURP組,差異均有統(tǒng)計(jì)學(xué)意義。術(shù)后并發(fā)癥方面,TUERP術(shù)的逆行射精率高于TURP術(shù),復(fù)發(fā)(需再次手術(shù))率TUERP術(shù)小于TURP術(shù),其余并發(fā)癥兩組差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論相對(duì)于TURP術(shù),TUERP術(shù)切除增生組織徹底,長(zhǎng)期療效好,并發(fā)癥少,逆行射精的發(fā)生率高,未發(fā)現(xiàn)因增生復(fù)發(fā)需再次行手術(shù)治療的患者。TUERP術(shù)可能挑戰(zhàn)TURP術(shù)的“金標(biāo)準(zhǔn)”地位,但仍需獲得多中心、大樣本、長(zhǎng)期的病例對(duì)照研究進(jìn)一步證實(shí)。第二章經(jīng)尿道雙極等離子前列腺剜除術(shù)與經(jīng)尿道雙極等離子前列腺電切術(shù)治療良性前列腺增生的隨機(jī)對(duì)照研究目的為了客觀的短期綜合評(píng)價(jià)TUERP術(shù)治療良性前列腺增生的可行性、有效性及安全性等情況。方法以TUERP術(shù)為試驗(yàn)組、TURP術(shù)為對(duì)照組,研究TUERP術(shù)患者的圍手術(shù)期情況,術(shù)前、術(shù)后3個(gè)月、6個(gè)月的PVR、PSA、Qmax、IPSS和QOL,以及術(shù)中、術(shù)后6個(gè)月內(nèi)并發(fā)癥的發(fā)生情況。結(jié)果相對(duì)于TURP術(shù),TUERP術(shù)的手術(shù)時(shí)間更短,術(shù)中出血量更少,血鈉稀釋的更少,手術(shù)效率更高,術(shù)后恢復(fù)更快;TUERP組術(shù)后隨診的PSA、IPSS、QOL值均小于TURP組,TUERP組術(shù)后的Qmax值大于TURP組,差異均有統(tǒng)計(jì)學(xué)意義;兩組間患者術(shù)中包膜穿孔、輸血及術(shù)后PVR、尿潴留、繼發(fā)性出血、尿道狹窄、尿失禁和膀胱頸攣縮的差異均無(wú)統(tǒng)計(jì)學(xué)意義。TUERP組的患者術(shù)后并發(fā)逆行射精較TURP組發(fā)生率高。結(jié)論相對(duì)TURP術(shù),TUERP術(shù)切除前列腺增生組織徹底、有效、安全,手術(shù)效率高,術(shù)中出血少,術(shù)后恢復(fù)快,短期手術(shù)療效好。TUERP術(shù)手術(shù)并發(fā)癥少,與TURP術(shù)無(wú)差異,但逆行射精的發(fā)生率較TURP高。TUERP術(shù)可能作為今后手術(shù)治療BPH的“金標(biāo)準(zhǔn)”。
[Abstract]:Benign prostatic hyperplasia (BPH) is a common disease that causes dysuria in middle-aged and aged men. TURP is the "golden standard" for the surgical treatment of BPH, especially the use of bipolar plasma electrocuter, which has a more obvious operation advantage. Transurethral bipolar plasma enucleation of the prostate (TUERP) has been carried out for more than ten years, but the long-term efficacy of this type of patients and whether it can challenge the "golden standard" status of TURP has not been reported. In this study, we conducted a long-term follow-up study and a short-term randomized controlled study of TUERP and TURP for the treatment of BPH, compared with "TURP" of "TURP". To evaluate the effect of TUERP in the treatment of benign prostatic hyperplasia (BPH), and to provide theoretical basis for the further application of TUERP. Chapter 1 A 10-year follow-up study of transurethral bipolar plasma enucleation of the prostate and transurethral resection of the prostate in the treatment of benign prostatic hyperplasia objective to evaluate the long-term efficacy of TUERP for 10 years. And recurrence and other complications and so on. Methods TURP was used as the control group. Prostate volume (PV), residual bladder urine volume (PVR), prostate specific antigen (PSA), maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QOL) and complications occurred 10 years after operation. Results the QOL values of PVP SAP IPSS QOL in TUERP group 10 years after operation were lower than those in TURP group 10 years after operation, and the Qmax value of TUERP group was higher than that of TURP group, and the difference was statistically significant. The rate of retrograde ejaculation in TUERP was higher than that in TURP. The recurrence rate of TUERP was lower than that of TURP. There was no significant difference in other complications between the two groups. Conclusion compared with TURP, TUERP has the advantages of complete resection of proliferative tissue, good long-term curative effect, less complications, and high incidence of retrograde ejaculation. The patients who do not find that the recurrence of hyperplasia need to be treated again may challenge the status of "golden standard" of TURP. But multicenter, large samples, and long-term case-control studies are needed. Chapter 2 A randomized controlled study of transurethral bipolar plasma enucleation of the prostate and transurethral resection of the prostate in the treatment of benign prostatic hyperplasia objective to evaluate the feasibility of TUERP in the treatment of benign prostatic hyperplasia in the short term. Effectiveness and safety. Methods TUERP was used as the control group. The perioperative period, preoperative, postoperative 3 months, 6 months PVR PSAQmaxIPSS and QOLs, and the complications during the operation were studied. Results compared with TURP, the operation time of TUERP was shorter, the amount of intraoperative bleeding was less, the blood sodium was diluted less, the operation efficiency was higher, and the postoperative follow-up QOL of TUERP group was lower than that of TURP group, and the Qmax of TUERP group was higher than that of TURP group, and the Qmax of TUERP group was lower than that of TURP group, and the Qmax of TUERP group was higher than that of TURP group. There were significant differences between the two groups: intraoperative capsular perforation, blood transfusion and postoperative PVR, urinary retention, secondary hemorrhage, urethral stricture, There was no significant difference between urinary incontinence and bladder neck contracture. The incidence of retrograde ejaculation in TUERP group was higher than that in TURP group. Conclusion compared with TURP, TUERP is complete, effective, safe, high efficiency, less bleeding, faster recovery after operation, and has less complications than TURP. There is no difference between TURP and TURP. But the incidence of retrograde ejaculation is higher than that of TURP. TUERP may be the golden standard for the treatment of BPH in the future.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699.8

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