TURP治疗大体积前列腺增生（≥80ml）安全性及有效性的前瞻性对照研究
发布时间：2019-06-11 16:33
【摘要】：背景与目的:对于前列腺体积大于80ml的良性前列腺增生(BPH)引起膀胱出口梗阻患者的外科治疗,目前仍是一个充满挑战的领域,经尿道前列腺电切术(TURP)仍被公认为是治疗中、小体积BPH患者(前列腺体积30-80ml)手术的“金标准”。随着电切镜器械和手术技巧的不断发展,TURP的手术并发症逐渐减少,故越来越多的泌尿外科医师尝试用TURP治疗大体积良性前列腺增生,并取得了很好的效果,但缺乏系统的、前瞻性的临床对照研究。本研究的目的是通过与治疗中、小体积BPH患者的手术效果对比,探讨TURP治疗大体积BPH患者(≥80ml)的安全性及有效性。方法:连续纳入2013年1月至2014年3月在我中心初次手术治疗的BPH患者共195例,根据前列腺体积大小将患者分为两组:A组(前列腺体积≥80ml,观察组):79例;B组(前列腺体积80ml,对照组):116例。分析患者年龄、ASA评分、PSA、膀胱残余尿量(PVR)、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)及合并症等临床资料,记录患者手术时间、术中切除前列腺组织重量、手术前后血红蛋白降低值、手术前后血清Na离子浓度降低值、留管时间、住院时间(LOS),围手术期并发症采用改良Clavien评分系统(CCS)详细记录并评分。术后3个月、6个月及12月对患者进行随访,评估指标包括IPSS、QOL、Qmax和PVR,记录尿路感染、尿道狭窄、膀胱颈挛缩、尿失禁、逆行射精等不良事件。结果:A、B两组术前临床资料对比A组的Qmax显著低于B组(P0.01),A组的PSA明显高于B组(P0.01),其它术前参数无显著统计学差异(P0.05),所有患者都顺利完成手术,A组手术时间较长、术中切除组织多、术后血红蛋白(Hb)降低较多(P0.01)。A、B两组对比术后血清Na离子浓度降低值、围手术期并发症CCS评分、术后留管时间、住院时间差异无统计学意义(P0.05)。A、B两组分别有75例和112例完成术后12月随访,术后12月复查A、B两组Qmax较术前都明显增加,A组从6.0±3.3ml/s增加至17.8±5.0ml/s(P0.01),B组从7.5±3.2ml/s增加至15.6±5.3ml/s(P0.01),IPSS评分都明显下降,A组从24.0±7.0降低至4.7±3.1(P0.01),B组从23.0±6.0降低至5.6±3.7(P0.01)。术后12月患者随访IPSS、QOL、PRV以及并发症发生率A、B两组间对比无显著统计学差异(P0.05),而A组的Qmax显著高于B组(P0.01)。结论:通过术后12月的随访我们可以得出结论,相对于治疗中、小体积前列腺增生患者,TURP治疗大体积BPH患者(≥80ml)同样是安全的、有效的,手术创伤小,术后恢复快,值得有经验的医院临床推广应用。
[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，
本文编号：2497328
[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，
本文编号：2497328
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