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目的:探讨经尿道前列腺电切术(TURP)和经尿道前列腺汽化切除术(TUVP)单独或联合治疗BPH的安全性和疗效。方法:2009年6月~2012年6月采用TURP和/或TUVP治疗BPH患者376例,其中TURP组116例,TUVP组125例,TURP与TUVP联合组(联合组)135例。经直肠B超检查计算三组前列腺重量分别为(81.3±22.8)、(78.5±21.5)和(82.2±20.6)g。比较三组之间手术时间、术中出血量、切除组织量、术后并发症等指标,以对比手术安全性;比较术前及术后3个月的Qmax、剩余尿量(RUV)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标,以对比其临床疗效。结果:TURP组、TUVP组和联合组的手术成功率分别为98.3%(114/116)、98.4%(123/125)和99.3%(134/135)(P>0.05);平均手术时间分别为(43.2±12.4)min、(55.3±14.5)min和(47.4±13.1)min(P<0.05);平均出血量分别为(220.4±50.5)ml、(85.5±24.6)ml和(100.4±30.2)ml(P<0.05);平均切除组织质量分别为(49.2±11.3)g、(52.7±13.3)g和(50.4±12.6)g(P>0.05);经尿道前列腺电切综合征(TURS)发生率分别为2.6%(3/116)、0.8%(1/125)和0.7%(1/135)(P<0.05);术后暂时性尿失禁发生率分别为1.7%(2/116)、4.8%(6/125)和1.5%(2/135)(P<0.05);术后3个月尿道狭窄发生率分别为1.7%(2/116)、4.0%(5/125)和1.5%(2/135)(P<0.05)。三组患者术后3个月的Q max均较术前明显增加(P<0.05),术后IPSS、QOL、RUV均较术前明显下降(P<0.05),三组之间各指标比较差异均无统计学意义(P>0.05)。结论:TURP、TUVP单独或联合均为治疗BPH的有效方法,TURP联合TUVP治疗兼有两者的优点,切割速度快,止血彻底,安全高效,并发症少,是治疗BPH的更好选择。
Objective: To investigate the safety and efficacy of transurethral resection of the prostate (TURP) and transurethral vaporization of the prostate (TUVP) alone or in combination. Methods: From June 2009 to June 2012, 376 patients with BPH were treated with TURP and / or TUVP, including 116 TURP patients, 125 TUVP patients and 135 TURP and TUVP combination patients. Transrectal ultrasound B calculated the weight of the three groups were (81.3 ± 22.8), (78.5 ± 21.5) and (82.2 ± 20.6) g. The operation time, intraoperative blood loss, amount of resected tissue and postoperative complications were compared between the three groups to compare the safety of operation. Qmax, residual urine volume (RUV) before and 3 months after surgery were compared between international Prostate Symptom Score (IPSS), quality of life score (QOL) and other indicators to compare their clinical efficacy. Results: The successful rates of operation in TURP group, TUVP group and combined group were 98.3% (114/116), 98.4% (123/125) and 99.3% (134/135) respectively (P> 0.05). The average operation time was The average amount of bleeding was (220.4 ± 50.5) ml, (85.5 ± 24.6) ml and (100.4 ± 30.2) ml, respectively. The average amount of bleeding was (43.2 ± 12.4) min, (55.3 ± 14.5) min and (47.4 ± 13.1) min (P <0.05). The average quality of resected tissue was (49.2 ± 11.3) g, (52.7 ± 13.3) g and (50.4 ± 12.6) g, respectively The rates of postoperative urinary incontinence were 2.6% (3/116), 0.8% (1/125) and 0.7% (1/135) respectively (P <0.05) 4.8% (6/125) and 1.5% (2/135) respectively (P <0.05). The incidence of urethral stricture at 3 months after operation was 1.7% (2/116), 4.0% (5/125) and 1.5% (2/135) (P <0.05). The Qmax of the three groups at 3 months after operation was significantly higher than that before operation (P <0.05). The IPSS, QOL and RUV after operation were significantly lower than those before operation (P <0.05), and there were significant differences among the three groups No statistical significance (P> 0.05). Conclusion: TURP and TUVP alone or in combination are effective methods for the treatment of BPH. The combination of TURP and TUVP has the advantages of both cutting speed, complete hemostasis, safe and efficient, less complications and is a better choice for the treatment of BPH.