本文選題：良性前列腺增生 + 鈥激光��； 參考：《安徽醫(yī)科大學》2014年碩士論文

【摘要】：目的針對良性前列腺增生患者接受兩種手術(shù)方式（經(jīng)尿道鈥激光前列腺剜除術(shù)與經(jīng)尿道前列腺電切術(shù)）后，對其手術(shù)時間、術(shù)后留置尿管時間、住院時間、術(shù)后并發(fā)癥發(fā)生率、早期癥狀改善情況、手術(shù)前后最大尿流率、國際前列腺癥狀評分、生活質(zhì)量評分等方面進行回顧性分析，對比兩種手術(shù)方式的治療效果。 方法自2012年6月至2013年7月收集合肥市第一人民醫(yī)院、合肥市第一人民醫(yī)院蜀山分院及合肥市濱湖醫(yī)院泌尿外科住院擬手術(shù)病人共有100例。就診原因以排尿困難、尿頻、尿急、尿痛等下尿路癥狀為主，在正規(guī)藥物治療無效后收住入院，排除糖尿病、帕金森綜合癥等一些可能致膀胱收縮無力的疾病后，行血清前列腺特異抗原、直腸指診(DRE)、經(jīng)直腸B超檢查、殘余尿量測量、最大尿流率檢查并且術(shù)后病理結(jié)果提示為良性前列腺增生，以門診就診為主。年齡61～87歲，平均72.1歲，病程4～20年，平均13年。其中伴有膀胱結(jié)石病例14例。既往有尿潴留病史者37例，曾行導尿病例67例�；加懈哐獕翰∈氛�32例，患有慢性支氣管炎者10例，患有冠心病及心率失常者9例。將這100例患者以隨機分組的方法分為兩組，每組50人。分別行經(jīng)尿道鈥激光前列腺剜除術(shù)和經(jīng)尿道前列腺電切術(shù)，，監(jiān)測、記錄2組患者術(shù)中出血量、經(jīng)尿道電切綜合征發(fā)生率、手術(shù)時間、膀胱沖洗時間、留管時間以及住院時間，并通過術(shù)后1個月、3個月及6個月復(fù)查指標，對比其最大尿流率、國際前列腺癥狀評分、生活質(zhì)量評分等變化并進行相關(guān)分析，從而對比兩者近期治療效果。 結(jié)果術(shù)前兩組患者術(shù)前一般情況和最大尿流率、國際前列腺癥狀評分、生活質(zhì)量評分以及前列腺重量比較，差異無統(tǒng)計學意義（P0.05）；在出血量比較中，經(jīng)尿道鈥激光前列腺剜除術(shù)組與經(jīng)尿道前列腺電切術(shù)組相比，其出血量較低，兩組差異有統(tǒng)計學意義(P0.05)；在經(jīng)尿道電切綜合征發(fā)生率上，經(jīng)尿道鈥激光前列腺剜除術(shù)組發(fā)生率明顯低于經(jīng)尿道前列腺電切術(shù)組，差異有統(tǒng)計學意義(P0.05)；在手術(shù)耗時、術(shù)后膀胱沖洗時間、導尿管留置天數(shù)及住院總天數(shù)的比較中，經(jīng)尿道鈥激光前列腺剜除術(shù)組與經(jīng)尿道前列腺電切術(shù)組相比，其時間較短，差異有顯著差異(P0.05)；術(shù)后1個月、3個月及6個月兩組中國際前列腺癥狀評分、生活質(zhì)量評分、最大尿流率與術(shù)前相比，均有明顯改善（P0.05）；但兩組間比較并無明顯差異（P0.05）。 結(jié)論經(jīng)尿道鈥激光前列腺剜除術(shù)與經(jīng)尿道前列腺電切術(shù)相比，近期療效相似，均可明顯改善患者生活質(zhì)量，但經(jīng)尿道鈥激光前列腺剜除術(shù)術(shù)后并發(fā)癥較少，術(shù)后恢復(fù)較快，可視為治療良性前列腺增生較好的新方法。
[Abstract]:Objective to investigate the time of operation, the time of indwelling urethral catheter, the time of hospitalization and the incidence of postoperative complications in patients with benign prostatic hyperplasia after transurethral holmium laser enucleation of the prostate and transurethral resection of the prostate.The improvement of early symptoms, the maximum urinary flow rate before and after operation, the international prostate symptom score and the quality of life score were analyzed retrospectively.Methods from June 2012 to July 2013, 100 patients were collected from Hefei first people's Hospital, Shushan Branch of Hefei first people's Hospital and Hefei Binhu Hospital.The main causes of the visit were dysuria, frequent urination, urgency, urinal pain, and other lower urinary tract symptoms. They were admitted to hospital after the failure of regular drug treatment, excluding diabetes mellitus, Parkinson's syndrome and other diseases that may cause bladder contraction weakness.Serum prostate-specific antigen (PSA), digital rectal diagnosis (DREN), transrectal B-mode ultrasonography, residual urine volume measurement, maximum uroflow rate examination and postoperative pathological results showed benign prostatic hyperplasia (BPH), mainly in outpatient clinic.The mean age was 72.1 years, and the course of disease ranged from 4 to 20 years (mean 13 years).Among them, 14 cases were accompanied with bladder calculi.There were 37 cases with history of urinary retention and 67 cases with urinary catheterization.There were 32 cases with history of hypertension, 10 cases with chronic bronchitis, 9 cases with coronary heart disease and arrhythmia.The 100 patients were randomly divided into two groups, 50 in each group.Transurethral holmium laser enucleation of the prostate and transurethral resection of the prostate were performed respectively. The amount of blood lost during the operation, the incidence of transurethral resection syndrome, the time of operation, the time of bladder irrigation, the time of stay of tube and the time of hospitalization were recorded.After 1 month, 3 months and 6 months after operation, the changes of maximal uroflow rate, international prostate symptom score and quality of life score were compared and analyzed.Results there was no significant difference between the two groups in preoperative general condition and maximal urine flow rate, international prostate symptom score, quality of life score and prostate weight (P 0.05).The bleeding volume of transurethral holmium laser enucleation of the prostate was lower than that of transurethral resection of the prostate (P 0.05), and the incidence of transurethral resection syndrome was higher than that of transurethral resection.The incidence of transurethral holmium laser enucleation of the prostate was significantly lower than that of transurethral resection of the prostate (P 0.05).The duration of transurethral holmium laser enucleation of the prostate was shorter than that of transurethral resection of the prostate (P 0.05), and the scores of international prostate symptom and quality of life were 1 month, 3 months and 6 months after operation.The maximum urinary flow rate was significantly improved compared with that before operation, but there was no significant difference between the two groups.Conclusion compared with transurethral holmium laser enucleation of the prostate, the short term curative effect is similar and the quality of life can be improved obviously. However, the complications after transurethral holmium laser enucleation of the prostate are less, and the recovery is faster after transurethral enucleation of the prostate.It can be regarded as a new method for the treatment of benign prostatic hyperplasia.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.8

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本文編號：1771942