经尿道双极等离子前列腺剜除术治疗良性前列腺增生伴膀胱结石的效果及其对患者性功能的影响-现代医学

经尿道双极等离子前列腺剜除术治疗良性前列腺增生伴膀胱结石的效果及其对患者性功能的影响

单位：1. 贵航平坝医院泌尿外科, 贵州安顺 561100;
2. 贵航安顺医院泌尿外科, 贵州安顺 561100

分类号：R697.32;R694.4

出版年·卷·期（页码）：2019·47·第五期（502-507）

摘要：

目的：探讨经尿道双极等离子前列腺剜除术（PKEP）治疗良性前列腺增生（BPH）伴膀胱结石的疗效及对患者性功能的影响。方法：选取2009年1月至2016年12月贵航平坝医院与贵航安顺医院收治的116例良性BPH伴膀胱结石患者，按随机抽签法分为观察组和对照组。观察组（n=58）实施PKEP治疗，对照组（n=58）实施经尿道双极等离子电切术（PKRP）。比较两组手术基础情况及术后并发症发生情况，术前及术后6个月对患者进行国际前列腺症状评分（IPSS）、生活质量评分（QOL）评分，测定残余尿量（PVR）、最大尿流率（Q_max）及性功能指标[国际勃起功能指数-5问卷表（ⅡEF-5）评分、逆行射精（RE）及勃起功能障碍（ED）发生率]。结果：两组膀胱碎石时间比较差异无统计学意义（P>0.05）；前列腺切除时间、术中出血量、术后膀胱冲洗时间、导尿管留置时间及住院时间方面，观察组均显著小于对照组（P<0.05）；术后暂时性尿失禁、膀胱痉挛、膀胱刺激征发生率观察组显著低于对照组（P<0.05）；术后6个月，两组IPSS评分、PVR、Q_max差异均无统计学意义（P>0.05），而QOL评分观察组显著低于对照组，且ⅡEF-5评分观察组显著高于对照组（P<0.05）；观察组ED和RE发生率分别为8.62%、25.86%，均显著低于对照组相应的25.86%、48.28%（P<0.05）。结论：PKEP治疗良性BPH伴膀胱结石安全有效，创伤小、术后恢复快、并发症少，对患者的性功能影响小。

Objective:To investigate the efficacy of transurethral bipolar plasmakinetic enucleation of prostate (PKEP) in treatment of benign prostate hyperplasia complicated with bladder stones and its influence on sexual function. Methods:116 cases of benign BPH patients complicated with bladder stones admitted to Guihang Pingba County Hospital and Guihang Anshun County Hospital from January 2009 to December 2016 were randomly divided into observation group and control group,58 cases in each group. The observation group was treated with PKEP, the control group was treated with transurethral bipolar plasmakinetic resection of prostate (PKRP). The basic situation of surgery and postoperative complications were compared between the two groups. The scores of International Prostate Symptomscore (IPSS) and Quality of Life (QOL) were evaluated before operationand at 6^th months after surgery, the post void residual volume (PVR), maximum fflow rate (Qmax) and sexual function indicators[International Erectile Dysfunction Index-5 Questionnaire (ⅡEF-5) score, retrograde ejaculation (RE) and erectile dysfunction (ED) incidence] were evaluated and compared. Results:There was no significant difference in the lithotripsy time of bladder stones between the two groups (P>0.05),while the time of prostatectomy, intraoperative bleeding, postoperative bladder irrigation time, urinary catheter retention time and hospital stay in the observation group were significantly lower than those in the control group (P<0.05). The postoperative incidences of temporary incontinence, bladder spasms, bladder irritation in the observation group were significantly lower than the control group (P<0.05).There were no significant differences in IPSS score, PVR and Q_max between the two groups at 6^th month after operation (P>0.05),while the QOL score in the observation group was significantly lower than that in the control group (P<0.05),the ⅡEF-5 score in the observation group was significantly higher than that in the control group (P<0.05).The incidence of ED and RE was 8.62% and 25.86% in the observation group, significantly lower than 25.86% and 48.28% in the control group, the difference was statistically significant (P<0.05). Conclusion:PKEP for the treatment of benign BPH with bladder stones is safe and effective with the advantages of minimal invasion, quick recovery and fewer complications, which has less disruption of sexual function.

参考文献：

[1] 于晓华,梁国庆,吴旻,等.上海、浙江两地男性良性前列腺增生患病率调查[J].中国男科学杂志,2015,29(1):35-38.
[2] 吴序立,郑培奎,黄伟雄.双极等离子电切联合经皮膀胱通道钬激光碎石治疗高龄高危前列腺增生合并膀胱结石[J].中国微创外科杂志,2015,15(4):332-335.
[3] HE L Y,ZHANG Y C,HE J L,et al.The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention[J].Asian J Androl,2016,18(1):134-139.
[4] 代庆德,段晓波,刘华伟,等.前列腺增生合并膀胱结石的微创治疗效果分析[J].国际泌尿系统杂志,2017,37(5):674-677.
[5] WU G,HONG Z,LI C,et al.A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia:a randomized clinical trial with 12-month follow-up[J].Lasers Med Sci,2016,31(4):599-604.
[6] 朱凌峰,谭建明.经尿道双极等离子前列腺剜除术治疗体积>60 ml前列腺增生的疗效分析[J].中国微创外科杂志,2016,16(5):394-398.
[7] ABOU-TALEB A,EL-SHAER W,KANDEEL W,et al.Bipolar plasmakinetic enucleoresection of the prostate:our experience with 245 patients for 3 years of follow-up[J].J Endourol,2017,31(3):300-306.
[8] DOG∨AN Y,URUÇ F,ARAS B,et al.The relationships between metabolic syndrome,erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia[J].Turk J Urol,2015,41(1):7-12.
[9] 杨术明,白建鹏,谭小琪,等.不同前列腺增生手术对男性性功能的影响[J].国际泌尿系统杂志,2015,35(3):397-399.
[10] 徐战平,刘久敏,郑祥光,等.保存膀胱颈完整性在经尿道前列腺等离子电切术中对低龄患者勃起功能的影响[J].南方医科大学学报,2014,34(11):1702-1704.
[11] 陈家明,金庭园,徐小明.经尿道双极等离子前列腺剜除术对良性前列腺增生尿道功能与性功能影响研究[J].中华肿瘤防治杂志,2015,22(11):183-184.
[12] 刘俊峰,刘春晓,谭朝晖,等.经尿道双极等离子前列腺剜除术与电切术后尿失禁发生率的随机对照研究[J].中华男科学杂志,2014,20(2):165-168.
[13] 龚德霖.不同术式治疗前列腺增生症对男性性功能影响的对比研究[J].东南大学学报(医学版),2017,36(6):974-977.
[14] 肖伟,杨科,高智勇,等.经尿道前列腺电切术与经尿道双极等离子电切术治疗良性前列腺增生比较分析及安全性评价[J].重庆医科大学学报,2014,38(1):76-79.
[15] 周汇文,田超.经尿道双极等离子前列腺剜除术对良性前列腺增生尿道功能与性功能的影响[J].中国医学创新,2017,14(4):130-132.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录