改良经尿道前列腺等离子剜除术对高龄高危前列腺增生病人围术期安全性评价

doi:10.3969/j.issn.1005-6483.2020.12.026

摘要/Abstract

摘要： 目的研究经尿道前列腺等离子剜除术(PKRP)治疗前列腺增生(BPH)的疗效，并分析术后膀胱颈痉挛的危险因素。
方法 2017年1月～2019年1月收治高龄高危BPH病人105例，根据其手术方式分为两组，改良组73例，行改良PKRP手术；传统组32例，行常规PKRP手术。比较两组治疗效果，统计改良组术后膀胱颈痉挛发生率。应用多因素Logistic回归模型，分析影响术后膀胱颈痉挛的危险因素。
结果改良组手术时间、术后冲洗时间、术后拔管时间及术后住院时间均短于传统组，术中出血量少于传统组，差异有统计学意义(P<0.05)。两组术中组织切除量比较，差异无统计学意义(P>0.05)；术后两组最大尿流率(MFR)均较同组术前上升，剩余尿(PVR)及国际前列腺症状评分(IPSS)均较术前显著下降，组内比较差异有统计学意义(P<0.05)，且改良组治疗后MFR水平高于传统组，PVR水平低于传统组，差异有统计学意义(P<0.05)；两组术后并发症发生率比较，差异无统计学意义(P>0.05)；Logistic多因素回归分析提示，吸烟史、术后导尿管堵塞将增加高龄高危BPH改良PKRP术后膀胱颈痉挛风险。
结论与传统PKRP术式相比，改良PKRP手术耗时更短，术中出血量更少，术后恢复更快，劝导病人戒烟、保持导尿管流畅，是预防术后膀胱颈痉挛的有效方式。

关键词: 改良尿道前列腺等离子剜除术, 前列腺, 疗效, 术后膀胱颈痉挛, 危险因素分析

Abstract: Objective To investigate curative effect of modified plasma kinetic resection of prostate(PKRP) for senile high-risk benign prostatic hyperplasia(BPH) and the risk factors of postoperative bladder neck contracture.
Methods The clinical date of 105 senile high-risk BPH patients in our hospital from January 2017 to January 2019 were retrospectively analyzed,and patients divided into two groups according to different surgical methods,modified group(n=73) and the traditional group(n=32).The outcomes of two groups were compared,and the incidence of postoperative bladder neck contracture in modified group was statistically analyzed.Then the risk factors affecting postoperative bladder neck contracture were analyzed by multivariate Logistic regression model.
Results The operative time,postoperative flushing time,postoperative extubation time and postoperative hospital stay of modified group were significantly shorter than those of traditional group(P<0.05),and the intraoperative blood loss was significantly less than that of traditional group(P<0.05).There was no significant difference in the amount of intraoperative tissue resection between two groups(P>0.05).After surgery,the maximum flow rate(MFR) was significantly increased in both groups,and postvoid residual(PVR) and international prostate symptom score(IPSS) were decreased significantly in both groups,with significant differences within groups(P<0.05).After treatment,MFR of modified group was significantly higher than that of traditional group,and PVR was significantly lower than that of traditional group(P<0.05).There was no significant difference in postoperative complications between groups(P>0.05).Logistic multivariate regression analysis suggested that smoking history and postoperative obstruction of urethral catheters would increase the risk of bladder neck contracture after surgery.
Conclusion Compared with traditional PKRP operation,the modified PKRP has the advantages of shorter operation time,less intraoperative blood loss,and faster postoperative recovery.The effective way to prevent bladder neck contracture includes quitting smoking and keeping catheter smooth.

Key words: modified plasma kinetic resection of prostate, prostate, effect, postoperative bladder neck contracture, risk factor

尹文利李双辉李永禄高峰李双标. 改良经尿道前列腺等离子剜除术对高龄高危前列腺增生病人围术期安全性评价[J]. 临床外科杂志, 2020, 28(12): 1171-1173.

YIN Wenli, LI Shuanghui, LI Yonglu, et al.. Evaluation of perioperative safety of modified urethral prostatectomy in elderly patients with high risk prostatic hyperplasia[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(12): 1171-1173.

参考文献

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