经尿道双极等离子前列腺剜除术与电切术治疗良性前列腺增生疗效比较的临床研究

发布时间：2018-07-20 18:27

【摘要】：良性前列腺增生(BPH)是引起中老年男性排尿障碍的常见病,TURP是目前公认的手术治疗BPH的“金标准”,特别是双极等离子电切器的投入使用,其手术优势更明显。经尿道双极等离子前列腺剜除术(TUERP)至今开展已十余年,但这类病人的长期疗效如何,能否挑战TURP术的“金标准”地位,目前尚未看到类似的报道。在本研究中我们以“金标准”的“经尿道双极等离子前列腺电切术(TURP)”为对照,开展TUERP术与TURP术治疗BPH术后10年长期的随诊研究和短期的随机对照研究,来综合评价TUERP术治疗前列腺增生的应用效果,为TUERP术的进一步推广应用提供理论依据。第一章经尿道双极等离子前列腺剜除术与经尿道双极等离子前列腺电切术治疗良性前列腺增生的10年随诊研究目的为了客观评价TUERP术后十年的长期疗效,以及复发等并发症等情况。方法以TURP术为对照组,研究TUERP术患者术前、术后10年的前列腺体积(PV)、膀胱残余尿量(PVR)、前列腺特异性抗原(PSA)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量指数评分(QOL)以及术后十年内并发症的发生情况。结果TUERP 组术后 10 年的 PV、PSA、IPSS、QOL 值均小于 TURP 组,TUERP组术后10年的Qmax值大于TURP组,差异均有统计学意义。术后并发症方面,TUERP术的逆行射精率高于TURP术,复发(需再次手术)率TUERP术小于TURP术,其余并发症两组差异无统计学意义。结论相对于TURP术,TUERP术切除增生组织彻底,长期疗效好,并发症少,逆行射精的发生率高,未发现因增生复发需再次行手术治疗的患者。TUERP术可能挑战TURP术的“金标准”地位,但仍需获得多中心、大样本、长期的病例对照研究进一步证实。第二章经尿道双极等离子前列腺剜除术与经尿道双极等离子前列腺电切术治疗良性前列腺增生的随机对照研究目的为了客观的短期综合评价TUERP术治疗良性前列腺增生的可行性、有效性及安全性等情况。方法以TUERP术为试验组、TURP术为对照组,研究TUERP术患者的围手术期情况,术前、术后3个月、6个月的PVR、PSA、Qmax、IPSS和QOL,以及术中、术后6个月内并发症的发生情况。结果相对于TURP术,TUERP术的手术时间更短,术中出血量更少,血钠稀释的更少,手术效率更高,术后恢复更快;TUERP组术后随诊的PSA、IPSS、QOL值均小于TURP组,TUERP组术后的Qmax值大于TURP组,差异均有统计学意义;两组间患者术中包膜穿孔、输血及术后PVR、尿潴留、继发性出血、尿道狭窄、尿失禁和膀胱颈挛缩的差异均无统计学意义。TUERP组的患者术后并发逆行射精较TURP组发生率高。结论相对TURP术,TUERP术切除前列腺增生组织彻底、有效、安全,手术效率高,术中出血少,术后恢复快,短期手术疗效好。TUERP术手术并发症少,与TURP术无差异,但逆行射精的发生率较TURP高。TUERP术可能作为今后手术治疗BPH的“金标准”。
[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.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R699.8

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