【摘要】：背景與目的:對(duì)于前列腺體積大于80ml的良性前列腺增生(BPH)引起膀胱出口梗阻患者的外科治療,目前仍是一個(gè)充滿挑戰(zhàn)的領(lǐng)域,經(jīng)尿道前列腺電切術(shù)(TURP)仍被公認(rèn)為是治療中、小體積BPH患者(前列腺體積30-80ml)手術(shù)的“金標(biāo)準(zhǔn)”。隨著電切鏡器械和手術(shù)技巧的不斷發(fā)展,TURP的手術(shù)并發(fā)癥逐漸減少,故越來(lái)越多的泌尿外科醫(yī)師嘗試用TURP治療大體積良性前列腺增生,并取得了很好的效果,但缺乏系統(tǒng)的、前瞻性的臨床對(duì)照研究。本研究的目的是通過(guò)與治療中、小體積BPH患者的手術(shù)效果對(duì)比,探討TURP治療大體積BPH患者(≥80ml)的安全性及有效性。方法:連續(xù)納入2013年1月至2014年3月在我中心初次手術(shù)治療的BPH患者共195例,根據(jù)前列腺體積大小將患者分為兩組:A組(前列腺體積≥80ml,觀察組):79例;B組(前列腺體積80ml,對(duì)照組):116例。分析患者年齡、ASA評(píng)分、PSA、膀胱殘余尿量(PVR)、國(guó)際前列腺癥狀評(píng)分(IPSS)、最大尿流率(Qmax)及合并癥等臨床資料,記錄患者手術(shù)時(shí)間、術(shù)中切除前列腺組織重量、手術(shù)前后血紅蛋白降低值、手術(shù)前后血清Na離子濃度降低值、留管時(shí)間、住院時(shí)間(LOS),圍手術(shù)期并發(fā)癥采用改良Clavien評(píng)分系統(tǒng)(CCS)詳細(xì)記錄并評(píng)分。術(shù)后3個(gè)月、6個(gè)月及12月對(duì)患者進(jìn)行隨訪,評(píng)估指標(biāo)包括IPSS、QOL、Qmax和PVR,記錄尿路感染、尿道狹窄、膀胱頸攣縮、尿失禁、逆行射精等不良事件。結(jié)果:A、B兩組術(shù)前臨床資料對(duì)比A組的Qmax顯著低于B組(P0.01),A組的PSA明顯高于B組(P0.01),其它術(shù)前參數(shù)無(wú)顯著統(tǒng)計(jì)學(xué)差異(P0.05),所有患者都順利完成手術(shù),A組手術(shù)時(shí)間較長(zhǎng)、術(shù)中切除組織多、術(shù)后血紅蛋白(Hb)降低較多(P0.01)。A、B兩組對(duì)比術(shù)后血清Na離子濃度降低值、圍手術(shù)期并發(fā)癥CCS評(píng)分、術(shù)后留管時(shí)間、住院時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。A、B兩組分別有75例和112例完成術(shù)后12月隨訪,術(shù)后12月復(fù)查A、B兩組Qmax較術(shù)前都明顯增加,A組從6.0±3.3ml/s增加至17.8±5.0ml/s(P0.01),B組從7.5±3.2ml/s增加至15.6±5.3ml/s(P0.01),IPSS評(píng)分都明顯下降,A組從24.0±7.0降低至4.7±3.1(P0.01),B組從23.0±6.0降低至5.6±3.7(P0.01)。術(shù)后12月患者隨訪IPSS、QOL、PRV以及并發(fā)癥發(fā)生率A、B兩組間對(duì)比無(wú)顯著統(tǒng)計(jì)學(xué)差異(P0.05),而A組的Qmax顯著高于B組(P0.01)。結(jié)論:通過(guò)術(shù)后12月的隨訪我們可以得出結(jié)論,相對(duì)于治療中、小體積前列腺增生患者,TURP治療大體積BPH患者(≥80ml)同樣是安全的、有效的,手術(shù)創(chuàng)傷小,術(shù)后恢復(fù)快,值得有經(jīng)驗(yàn)的醫(yī)院臨床推廣應(yīng)用。
[Abstract]:Background & AIM: surgical treatment of bladder outlet obstruction caused by benign prostatic hyperplasia (BPH) with prostate volume larger than 80ml is still a challenging field. Transurethral resection of prostate (TURP) is still recognized as the "gold standard" for the treatment of patients with small volume BPH (prostate volume 30-80ml). With the continuous development of electrosurgical instruments and surgical techniques, the surgical complications of TURP are gradually reduced, so more and more urologists try to use TURP in the treatment of large volume benign prostatic hyperplasia (BPH), and have achieved good results, but lack of systematic and prospective clinical comparative study. The purpose of this study was to investigate the safety and efficacy of TURP in the treatment of patients with large volume BPH (鈮，

本文編號(hào)：2497328