同期行经尿道膀胱肿瘤电切术并良性前列腺增生电切术的临床观察

发布时间：2018-08-11 13:46

【摘要】：目的：探讨膀胱肿瘤合并良性前列腺增生患者同期行经尿道膀胱肿瘤电切术并良性前列腺增生电切术的可行性及疗效，为临床治疗膀胱肿瘤合并良性前列腺增生提供一定的指导。方法：回顾性分析我院自2009-03-01至2013-03-01收治的膀胱肿瘤合并良性前列腺增生患者共121例，其中同期行经尿道膀胱肿瘤电切术并良性前列腺增生电切术62例（A组），单纯行经尿道膀胱肿瘤电切术59例（B组），通过对两组术前、术后的临床指标，术后的临床疗效、并发症及肿瘤复发情况进行比较，以探讨同期行经尿道电切手术治疗膀胱肿瘤合并良性前列腺增生的可行性及治疗效果。结果：两组患者均顺利完成手术。A组术后随访9-36个月，平均22.50个月；B组术后随访7-36个月，平均22.75个月。 1同期行经尿道电切手术与单纯行膀胱肿瘤电切术比较，可明显改善患者排尿症状。术后随访6个月，A组患者平均I-PSS评分、QOL评分与术前比较，均具有显著性差异（P0.01）；B组患者平均I-PSS评分、QOL评分与术前比较，均无显著性差异（P0.05）。经组间比较，两组术前I-PSS评分、QOL评分均无显著性差异（P0.05）；术后A组患者排尿症状的改善明显优于B组患者，两组I-PSS评分、QOL评分的比较均具有显著性差异（P0.01）。B组患者中有6例于随访期内因良性前列腺增生行经尿道前列腺电切术，术后尿频、尿急、排尿困难等症状较术前均明显改善。 2两组患者均成功完成手术。通过对两组手术时间、出血量、膀胱冲洗时间、尿管保留时间的比较，A组患者较B组患者的手术时间明显延长，术中出血量明显增加，同时术后膀胱冲洗时间及尿管保留时间亦明显延长，均具有显著性差异（P0.01）；但两组住院时间比较无显著性差异（P0.05）。 3同期行经尿道电切手术与单纯行膀胱肿瘤电切术比较，不会增加术后并发症的发生率。A组患者中有3例出现闭孔神经反射，3例并发术后出血，2例出现尿路感染，2例并发尿道狭窄；B组患者中有4例出现闭孔神经反射，2例并发术后出血，3例出现尿路感染，1例并发尿道狭窄。两组患者中均未出现穿孔、尿失禁、TURS、勃起功能障碍等并发症。经组间比较，两组术后并发症的发生率无显著性差异（P0.05）。 4术后随访期内，，A组患者中有7例复发，平均复发时间为16.86±7.08个月，其中单发5例，多发2例；B组患者中亦有7例复发，平均复发时间为18.43±8.00个月，其中单发4例，多发3例。经组间比较，两组术后膀胱肿瘤的复发率无显著性差异（P0.05），复发时间亦无显著性差异（P0.05）。两组复发的膀胱肿瘤均无原位复发，均未发现尿道及前列腺窝的种植转移。复发的患者再次行经尿道膀胱肿瘤电切术后，随访期内均未再复发。结论： 1同期施行经尿道电切手术与单纯行经尿道膀胱肿瘤电切术相比，不会延长患者的住院时间，但可明显增加其手术时间、术中出血量及术后膀胱冲洗时间、尿管保留时间。 2同期施行经尿道电切手术与单纯行经尿道膀胱肿瘤电切术比较，在解除下尿路梗阻症状的同时，不会增加术后并发症的发生率及膀胱肿瘤的复发率，没有缩短膀胱肿瘤术后复发的时间，同时也未发现有前列腺窝及尿道处的种植转移。具有安全、疗效可靠、减轻患者痛苦和减少治疗费用的优势。
[Abstract]:Objective: To investigate the feasibility and efficacy of transurethral resection of bladder tumor combined with benign prostatic hyperplasia (BPH) in patients with bladder tumor and BPH.
Methods: 121 cases of bladder tumor complicated with benign prostatic hyperplasia from March 2009 to March 2013 were retrospectively analyzed. 62 cases underwent transurethral resection of bladder tumor and benign prostatic hyperplasia (group A) and 59 cases underwent transurethral resection of bladder tumor (group B). Objective:To evaluate the feasibility and efficacy of transurethral resection of bladder tumor combined with benign prostatic hyperplasia.
Results: Both groups were successfully completed surgery. Group A was followed up for 9-36 months, with an average of 22.50 months. Group B was followed up for 7-36 months, with an average of 22.75 months.
After 6 months of follow-up, the average I-PSS score and QOL score in group A were significantly different from those before operation (P 0.01); the average I-PSS score and QOL score in group B were not significantly different from those before operation (P 0.05). There was no significant difference in preoperative I-PSS score and QOL score between the two groups (P 0.05). The improvement of urinary symptoms in group A was significantly better than that in group B. There were significant differences in I-PSS score and QOL score between the two groups (P 0.01). Six patients in group B underwent transurethral resection of prostate for benign prostatic hyperplasia during the follow-up period. Symptoms such as frequent micturition, urgency of urination, dysuria and so on were significantly improved compared with those before operation.
The operation time, bleeding volume, bladder irrigation time and urethral retention time in group A were significantly longer than those in group B. The bleeding volume and bladder irrigation time and urethral retention time in group A were significantly longer than those in group B (P 0.01). But there was no significant difference in the length of stay between the two groups (P0.05).
There were 3 cases of obturator nerve reflex, 3 cases of postoperative hemorrhage, 2 cases of urinary tract infection and 2 cases of urethral stricture in group A, 4 cases of obturator nerve reflex, 2 cases of postoperative hemorrhage and 3 cases of postoperative hemorrhage in group B. No complications such as perforation, urinary incontinence, TURS, erectile dysfunction were found in either group. There was no significant difference in the incidence of postoperative complications between the two groups (P 0.05).
During the follow-up period, 7 cases in group A had recurrence, with an average recurrence time of 16.86 (+ 7.08 months), including 5 cases of single recurrence and 2 cases of multiple recurrence; 7 cases in group B had recurrence, with an average recurrence time of 18.43 (+ 8.00 months), including 4 cases of single recurrence and 3 cases of multiple recurrence. There was no significant difference in time between the two groups (P 0.05). There was no recurrence in situ and no implantation metastasis of urethra or prostatic fossa was found in both groups.
Conclusion:
Compared with transurethral resection of bladder tumor, transurethral resection of bladder tumor at the same time did not prolong the hospitalization time, but significantly increased the operation time, intraoperative bleeding volume, bladder irrigation time and urethral retention time.
Compared with transurethral resection of bladder tumor, transurethral resection of bladder tumor at the same time did not increase the incidence of postoperative complications and the recurrence rate of bladder tumor, did not shorten the recurrence time of bladder tumor, and did not find implantation metastasis of prostate fossa and urethra. It has the advantages of safety, reliable curative effect, relieving patient's pain and reducing treatment cost.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

【引证文献】