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目的探讨比较经尿道等离子前列腺剜除术(PKEP)与经尿道前列腺电切术(TURP)对重度良性前列腺增生(BPH)的疗效及安全性。方法收治BPH患者随机分为PKEP和TURP组,分别比较两组患者手术时间(OT)、术中出血(BL)、腺体切除质量(RTW)、腺体切除率(GRR),术后尿管留置时间(IUT)、膀胱造瘘管留置时间(BFUT)、住院时间(HST),以及术前术后血钠浓度(SSC)、前列腺质量(PW)、血红蛋白浓度(HGB)、残余尿(RUV)、最大尿流率(Q_(max))、勃起功能国际问卷(IIEF-5)、生活质量(QOL)、国际前列腺评分(IPSS)和主要并发症。结果两组间OT、BL、IUT、BFUT、HST、RTW、GRR、PW差值、HGB差值、SSC差值及术后PW、HGB、SSC有明显差异(P<0.01)。PKEP组患者膀胱痉挛、暂时性尿失禁、逆行射精、膀胱颈挛缩或尿道狭窄发生率明显低于TURP组(P<0.01),PKEP组闭孔神经反射、包膜穿孔、输血、继发性出血、ED发生率稍低于TURP组(P<0.05)。两组间术后IIEF-5及IIEF-5差值有明显差异(P<0.01)。两组术后IPSS、QOL、Q_(max)、RUV与术前比较差异有统计学意义(P<0.01),但两组间术前、术后及其差值比较均无明显差异(P>0.05)。结论与TURP相比,PKEP对重度BPH具有相同的满意疗效,同时具备出血少、时间短、切除彻底及并发症少等优点,是治疗BPH有效、安全的方法。
Objective To investigate the efficacy and safety of transurethral plasmaphotonotomy (PKEP) and transurethral resection of prostate (TURP) for severe benign prostatic hyperplasia (BPH). Methods Patients with BPH were randomly divided into PKEP and TURP groups. The operative time (OT), intraoperative bleeding (BL), mass excision of the gland (RTW), glandular resection rate (GRR) IUT, BFUT, HST, preoperative and postoperative serum sodium concentration (SSC), prostatic mass (PW), hemoglobin concentration (HGB), residual urine (RUV) , Maximum flow rate (Q max), IIEF-5, quality of life (QOL), international prostate score (IPSS) and major complications. Results The differences of OT, BL, IUT, BFUT, HST, RTW, GRR, PW, HGB, SSC and postoperative PW, HGB and SSC were significantly different between the two groups (P <0.01). The incidence of cystospasm, temporary urinary incontinence, retrograde ejaculation, bladder neck contracture or urethral stricture in PKEP group was significantly lower than that in TURP group (P <0.01), obstructive nerve reflex, perforation, blood transfusion and secondary hemorrhage in PKEP group The incidence of ED was slightly lower than that of TURP group (P <0.05). There was a significant difference between the two groups in postoperative IIEF-5 and IIEF-5 (P <0.01). There were significant differences in IPSS, QOL, Qmax and RUV between the two groups before and after operation (P <0.01), but there was no significant difference between the two groups in preoperative, postoperative and postoperative differences (P> 0.05). Conclusions Compared with TURP, PKEP has the same satisfactory curative effect on severe BPH, and has the advantages of less bleeding, short time, thorough resection and less complications, and is an effective and safe method for treating BPH.