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经尿道前列腺等离子剜除联合前列腺等离子电切术治疗前列腺增生症的有效性和安全性研究
作者:徐汉军  单勇  刘仁杰 
单位:泰州市第二人民医院 泌尿外科, 江苏 泰州 225500
关键词:前列腺增生症 前列腺等离子电切术 经尿道前列腺等离子剜除 联合手术 学习曲线 
分类号:R699.8
出版年·卷·期(页码):2022·50·第三期(330-335)
摘要:

目的:分析经尿道前列腺等离子剜除(PKEP)联合前列腺等离子电切术(PKRP)治疗前列腺增生症(BPH)的有效性和安全性。方法:选取我院71例BPH患者为研究对象,以单盲法按照随机数字表简单随机分组法分为对照组(36例)及观察组(35例),对照组给予PKRP治疗,观察组给予PKEP联合PKRP治疗。记录两组围手术期指标及围手术期并发症发生情况,比较两组术前及术后3个月前列腺体积、前列腺症状评分(IPSS)、BPH患者生活质量量表(BPHQLS) 评分及尿流动力学[残余尿量(PVR)、最大尿流率(Qmax)],并绘制观察组手术学习曲线,分析手术稳定所需的手术例数,利用Pearson相关性分析评估手术例数与手术时间的相关性。结果:两组手术时间及围手术期并发症比较,差异无统计学意义(P>0.05);观察组术中出血量少于对照组(P<0.05),术后膀胱冲洗时间、术后导尿管拔除时间、术后住院时间均短于对照组(P<0.05),切除组织重量大于对照组(P<0.05)。术后3个月时,两组前列腺体积较术前减小(P<0.05),IPSS较术前降低(P<0.05),PVR较术前减少(P<0.05),且观察组变化幅度大于对照组(P<0.05);两组BPHQLS评分均较术前显著升高(P<0.05),Qmax较术前增大(P<0.05),且观察组变化幅度更大(P<0.05)。观察组手术学习曲线可见,随着手术例数的增加,手术时间逐渐缩短,在20例后手术时间趋于平稳,且手术例数与手术时间呈负相关(r=-0.968,P<0.001)。结论:PKEP联合PKRP治疗BPH有效且安全,手术学习曲线不长,适合在基层医疗机构推广应用。

Objective: To analyze the effectiveness and safety of transurethral plasmakinetic enucleation of prostate(PKEP) combined with plasmakinetic resection of prostate(PKRP) in the treatment of benign prostatic hyperplasia(BPH). Methods: 71 patients with BPH in the hospital were selected and divided into control group(36 cases) and observation group(35 cases) by the simple random grouping method of random number table according to single blind method. The control group was given PKRP, and the observation group was given PKEP combined with PKRP. Perioperative indicators and occurrence of perioperative complications were recorded in the two groups. Prostate volume, International Prostate Symptom Score(IPSS), BPH Quality of Life Scale(BPHQLS) score and urodynamics [post-voiding residual(PVR), maximum urinary flow rate(Qmax)] were compared before surgery and at 3 months after surgery. Surgical learning curve was drawn in observation group to analyze the number of surgical cases required for surgical stabilization, and Pearson correlation analysis was applied to evaluate the correlation between the number of surgical cases and surgical time. Results: There were no statistical differences in surgical time and perioperative complications between the two groups(P>0.05). Intraoperative blood loss was less(P<0.05), postoperative bladder irrigation time, postoperative catheter removal time and postoperative hospital stay were shorter(P<0.05) and the weight of removed tissue was heavier(P<0.05) in observation group compared to control group. At 3 months after surgery, prostate volume, IPSS and PVR of the two groups were reduced compared with those before surgery(P<0.05), and the changes in observation group were greater than those in control group(P<0.05). BPHQLS score and Qmax of the two groups were significantly enhanced compared with those before surgery(P<0.05), and the changes were greater in observation group(P<0.05). Surgical learning curve of observation group showed that with the increase of the number of surgical cases, the surgical time was gradually shortened. After 20 cases, surgical time stabilized and the number of surgical cases was negatively correlated with surgical time(r=-0.968, P<0.001). Conclusion: The combination of PKEP and PKRP are effective and safe in treating BPH, and their learning curve of surgery are not long. They are suitable for popularization and application in primary medical institutions.

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