本文選題：前列腺增生(BPH)　切入點(diǎn)：經(jīng)尿道前列腺等離子切除術(shù)(TUPKP)　出處：《泰山醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的:評(píng)價(jià)目前手術(shù)治療前列腺增生(BPH)的方法,即經(jīng)尿道前列腺等離子切除術(shù)(TUPKP)和經(jīng)尿道前列腺電切術(shù)(TURP),包括臨床療效和手術(shù)安全性。方法:實(shí)驗(yàn)組分為兩組,即TURP組和TUPKP組。TURP組,從2011年1月-10月泰山醫(yī)學(xué)院附屬鄒平縣人民醫(yī)院泌尿外科收治的確診為BPH的患者中隨機(jī)抽取110例,行TURP手術(shù)治療;TUPKP組,從2013年1月-2013年10月同科室收治的確診為BPH的患者中隨機(jī)抽取140例,行TUPKP手術(shù)治療。應(yīng)注意2組患者應(yīng)統(tǒng)一納入和剔除的標(biāo)準(zhǔn),并做術(shù)前PSA值的常規(guī)檢測(cè),測(cè)量前列腺體積,通過(guò)直腸指診檢查明確前列腺有無(wú)異常增生結(jié)節(jié)、大體形態(tài)和質(zhì)地等情況,以及其它術(shù)前常規(guī)檢查。應(yīng)注意,必須充分了解泌尿系統(tǒng)有無(wú)其他病變和病史。在實(shí)驗(yàn)中,全面觀察2組患者的手術(shù)經(jīng)歷時(shí)間、手術(shù)中出血量、手術(shù)結(jié)束時(shí)血液中鈉離子等離子濃度的變化、手術(shù)結(jié)束后血糖的高低,手術(shù)前和手術(shù)后1個(gè)月分別進(jìn)行國(guó)際前列腺癥狀評(píng)分(IPSS)、殘余尿量(RUV)、最大尿流率(Qmax)、生活質(zhì)量評(píng)分(QOL),觀察手術(shù)并發(fā)癥及其轉(zhuǎn)歸等情況。結(jié)果:TUPKP組在平均手術(shù)時(shí)間,術(shù)中出血量,術(shù)后平均沖洗時(shí)間等均較TURP組明顯下降(P0.05);TURP組手術(shù)結(jié)束時(shí)血鈉、血糖值與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),TUPKP組手術(shù)結(jié)束時(shí)血鈉及血糖值與術(shù)前比較差異無(wú)明顯的變化(P0.05)。手術(shù)后1個(gè)月2組間上述指標(biāo)比較均無(wú)明顯差異性變化(均P0.05),手術(shù)后1個(gè)月IPSS、QOL、Qmax、RUV測(cè)試值與手術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義(均P0.01),并且術(shù)后各種并發(fā)征比較差異均有統(tǒng)計(jì)學(xué)意義(均P0.05)。結(jié)論:TURP、TUPKP均是目前經(jīng)尿道切除增生前列腺的有效的外科手術(shù)治療方法,均可明顯改善下尿路梗阻的相關(guān)癥狀。實(shí)驗(yàn)中TUPKP組患者在手術(shù)中沒(méi)有發(fā)生電切綜合征,手術(shù)中出血量較少,實(shí)驗(yàn)結(jié)果表明手術(shù)對(duì)機(jī)體血糖、血中鈉離子濃度無(wú)明顯影響,手術(shù)并發(fā)癥總發(fā)生率明顯少于TURP組,因此根據(jù)實(shí)驗(yàn)結(jié)果,TUPKP手術(shù)較為安全,是目前經(jīng)尿道治療BPH理想的手術(shù)方法。但因本試驗(yàn)樣本數(shù)有限,隨訪時(shí)間較短,需要增大樣本量進(jìn)行對(duì)照試驗(yàn)來(lái)進(jìn)一步證實(shí)此結(jié)論。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of transurethral prostatectomy (TUPKP) and transurethral resection of prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH).Methods: the experimental group was divided into two groups: TURP group and TUPKP group. From January to October 2011, 110 patients with BPH were selected randomly from Urology Department of Zouping County people's Hospital affiliated to Taishan Medical College.From January 2013 to October 2013, 140 patients with BPH were randomly selected and treated with TUPKP.Attention should be paid to the standard of inclusion and exclusion of the two groups, routine examination of preoperative PSA value, measurement of prostate volume, and determination of abnormal hyperplastic nodules, gross morphology and texture of the prostate by rectal digital examination.And other routine preoperative examinations.Attention should be paid to the need to fully understand whether the urinary system has other lesions and history.In the experiment, the time of operation, the amount of blood loss during operation, the concentration of sodium ion and plasma in blood, the level of blood glucose after operation were observed.International prostatic symptom score (IPSS), residual urine volume (RUV), maximum flow rate (Qmax), quality of life (QOL) were evaluated before operation and 1 month after operation respectively. The complications and prognosis of the operation were observed.Results compared with the TURP group, the average operative time, intraoperative blood loss and postoperative irrigation time in the TUPKP group were significantly lower than those in the TURP group, and the blood sodium was decreased at the end of the operation in the TUPKP group.There was no significant difference in blood sodium and blood glucose between the two groups at the end of operation.There was no significant difference in the above indexes between the two groups at one month after operation (all P 0.05), and the RUV values of IPSS QOLQmax Qmax 1 month after operation were significantly different from those before operation (all P 0.01), and there were significant differences in all kinds of complications after operation.Statistical significance (P 0.05).Conclusion TURP- TUPKP is an effective surgical treatment for prostatectomy of prostatic hyperplasia by transurethral resection, which can obviously improve the symptoms of lower urinary tract obstruction.In the TUPKP group, there was no electrocution syndrome and less bleeding during the operation. The results showed that the operation had no significant effect on blood glucose and serum sodium concentration, and the total incidence of complications was significantly lower than that in the TURP group.Therefore, according to the experimental results, TUPKP is safe and is an ideal method for transurethral treatment of BPH.However, due to the limited sample size and short follow-up time, it is necessary to increase the sample size to further confirm this conclusion.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R699.8

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本文編號(hào)：1725486