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目的探讨经尿道双极等离子腔内前列腺剜除术(plasmakinetic enucleation of the prostate,PKEP)治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)的疗效。方法 2010年10月~2014年6月PKEP治疗360例BPH,电切镜在精阜近端6点位置向下点触式切开黏膜至外科包膜后,以镜鞘将腺体沿包膜平面钝性向膀胱颈逆推剥离,先将中叶撬拔剜除切除,再行左右叶剜除,12点方向切除前列腺前联合处增生的前列腺组织,靠近膀胱颈部7点和8点处前列腺组织不予完全剥离,以免腺体整个滑入膀胱,将游离剜除的前列腺组织快速来回切除直到完整切除,最后修整创面。结果 360例手术均获成功,手术时间30~160 min,(62.5±15.9)min;术中出血量50~180 ml,(70.6±15.2)ml;切除腺体50~160 g,(50.5±20.9)g;术后留置尿管72~168 h,(96.2±8.5)h;膀胱冲洗时间12~72 h,(30.2±2.6)h;住院时间3~12 d,(3.6±2.5)d。术后血红蛋白降低(1.5±1.2)g/L。术后1、3个月IPSS分别为(6.5±1.7)、(5.3±1.8)分,显著低于术前(23.5±3.1)分(q=140.818,P<0.05;q=150.758,P<0.05);术后1、3个月QOL分别为(1.9±1.2)、(1.3±0.6)分,显著低于术前QOL(4.3±1.5)分(q=39.192,P<0.05;q=48.990,P<0.05);术后1、3个月Qmax中位数分别为15.0 ml/s(11.8~26 ml/s)、15.2 ml/s(13.0~26 ml/s),显著高于术前Qmax中位数5 ml/s(3.1~9.0 ml/s)(Z=-21.276,P=0.000;Z=-24.681,P=0.000);术后1、3个月RUV分别为(25.6±10.2)、(20.6±5.6)ml,显著低于术前RUV(80.5±35.6)ml(q=48.172,P<0.05;q=52.559,P<0.05)。结论 PKEP治疗BPH安全可靠,切除彻底,出血少,恢复快,并发症少,值得推广。
Objective To evaluate the efficacy of transurethral bipolar plasmapnetic prostatectomy (PKEP) in the treatment of benign prostatic hyperplasia (BPH). Methods From October 2010 to June 2014, 360 cases of BPH were treated with PKEP. The resected mucosa was excised by surgical resection at the 6 o’clock position of the proximal end of Jingfu, Bladder back to the blunt bladder thrust stripping, the first removal of the middle of the pry pull, 再, and then leaves about,,, 12 o’clock resection of the anterior prostate joint hyperplasia of prostate tissue, near the bladder neck at 7 o’clock and 8 o’clock at the prostate tissue Do not completely peel, so as not to slide the gland into the bladder as a whole, the free removal of prostate tissue quickly removed back and forth until the complete resection, the final dressing wound. Results All the surgeries were successful in 360 operations, with a mean time of operation of 30 to 160 minutes (62.5 ± 15.9) min, intraoperative blood loss of 50 to 180 ml (70.6 ± 15.2) ml, resected glands of 50 to 160 g, (50.5 ± 20.9) ) g. Postoperative catheterization was performed for 72 to 168 h (96.2 ± 8.5 h). The bladder irrigation time ranged from 12 to 72 h (30.2 ± 2.6) h and the length of stay was from 3 to 12 d (3.6 ± 2.5) d. Postoperative hemoglobin decreased (1.5 ± 1.2) g / L. The IPSS at 1 month and 3 months after operation were (6.5 ± 1.7) and (5.3 ± 1.8) points, respectively, which were significantly lower than those before operation (23.5 ± 3.1) (q = 140.818, P <0.05; ). QOL at 1 month and 3 months after operation were (1.9 ± 1.2) and (1.3 ± 0.6) points, respectively, which were significantly lower than those before operation (q = 39.192, q = 48.990, P <0.05). The median Qmax at 1 and 3 months postoperatively were 15.0 ml / s (11.8-26 ml / s) and 15.2 ml / s (13.0-26 ml / s) The median of RUV was (5) (25.6 ± 10.2) at 5 and 13 months postoperatively (P = 0.000; Z = -24.681, P = , (20.6 ± 5.6) ml respectively, which was significantly lower than preoperative RUV (80.5 ± 35.6) ml (q = 48.172, P <0.05; q = 52.559, P <0.05). Conclusion The treatment of BPH is safe, reliable, complete removal, less bleeding, rapid recovery, fewer complications and worthy of promotion.