Effects of transurethral vapor enucleation and resection of prostate on urination function and sexual function in patients with BPH
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摘要: 为了探究经尿道纽扣电极前列腺剜除术(TVERP)治疗对良性前列腺增生(BPH)患者排尿功能和性功能的影响，选取协和江北医院84例BPH患者为研究对象，采用随机数字表简单随机分组法分为TVERP组及经尿道前列腺等离子切除术(PKRP)组，各42例，并纳入同期行经尿道双极等离子体前列腺剜除术(TUERP)治疗的42例BPH患者(TUERP组)。记录3组围术期指标、围术期并发症发生情况，并比较其术前及术后6个月国际前列腺症状评分(IPSS)、前列腺体积、排尿功能[最大尿流率(Qmax)、残余尿量(PVR)]及性功能[勃起功能(国际勃起功能指数-5)、性生活频率]差异。结果显示TVERP组与TUERP组手术时间、前列腺切除重量、术后血红蛋白下降值、导尿管留置时间、术后住院时间比较，差异均无统计学意义(P＞0.05)，但均优于PKRP组(P＜0.05)。3组围术期并发症比较，差异无统计学意义(P＞0.05)。术后6个月时，2组IPSS评分、前列腺体积及PVR均较术前降低(P＜0.05)，且TVERP组低于PKRP组(P＜0.05)；Qmax及国际勃起功能指数-5评分、性生活频率则较术前升高(P＜0.05)，且TVERP组高于PKRP组(P＜0.05)。提示TVERP术与TUERP术近期效果相当，较PKRP术能更为彻底切除增生前列腺组织，术中出血控制效果好，且TVERP术后BPH患者排尿功能及性功能恢复较好，是一种安全、有效的微创术式。
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关键词:
- 良性前列腺增生 /
- 经尿道纽扣电极前列腺剜除术 /
- 经尿道前列腺等离子切除术 /
- 经尿道双极等离子体前列腺剜除术 /
- 排尿功能 /
- 性功能
Abstract: We explored the effects of transurethral vapor enucleation and resection of prostate (TVERP) on urination function and sexual function in patients with benign prostatic hyperplasia (BPH). A total of 84 patients with BPH in our hospital were selected as the research subjects, and they were divided into TVERP group and plasmakinetic resection of the prostate (PKRP) group by simple random grouping of random number table method, with 42 cases in each group. Clinical data of 42 patients with BPH who underwent transurethral enucleation resection of prostate (TUERP) (TUERP group) were included. The perioperative indicators and occurrence of perioperative complications were recorded in the three groups, and the international prostate symptom score (IPSS), prostate volume, urinary function [maximum urine flow rate (Qmax), postvoid residual urine (PVR)] and sexual function {erectile function [International Index of Erectile Function-5 (IIEF-5)], frequency of sexual life} were compared between the two groups before surgery and at 6 months after surgery. There were no significant differences in the surgical time, prostatectomy weight, postoperative hemoglobin decrease, catheter indwelling time or postoperative hospital stay between TVERP group and TUERP group (P> 0.05), and the above indexes were lower than those in PKRP group (P< 0.05). There were no significant differences in the perioperative complications among the three groups (P> 0.05). At 6 months after surgery, the IPSS score, prostate volume and PVR of the two groups were lower than those before surgery (P< 0.05), and the indexes in TVERP group were lower than those in PKRP group (P< 0.05). The Qmax, IIEF-5 score and frequency of sexual life were higher than those before surgery (P< 0.05), and the indexes in TVERP group were higher than those in PKRP group (P< 0.05). TVERP has the same short-term effects as TUERP, and compared with PKRP, TVERP can remove the hyperplastic prostate tissue more thoroughly, and it has a better effect on controlling intraoperative blood loss. Besides, TVERP has better recovery of postoperative urination function and sexual function of patients with BPH after surgery. It is a safe and effective minimally invasive surgery. -
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表 1 3组围术期指标比较
X±S 组别 手术时间/min 前列腺切除重量/g 术后血红蛋白下降/(g·L-1) 导尿管留置时间/d 术后住院时间/d TVERP组(n=42) 82.69±15.711) 43.58±8.051) 1.61±0.471) 4.21±0.891) 5.84±1.311) TUERP组(n=42) 84.44±16.181) 42.39±7.681) 1.79±0.551) 4.41±0.861) 5.96±1.221) PKRP组(n=42) 117.22±19.33 29.15±6.27 10.25±1.92 5.90±1.24 7.32±1.49 F 54.032 49.563 729.607 35.004 15.702 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 与PKRP组比较，1)P＜0.05。 
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表 2 3组围术期并发症比较
例(%) 组别 尿失禁 膀胱颈挛缩 尿道狭窄 尿路感染 合计 TVERP组(n=42) 1(2.38) 0 0 0 1(2.38) TUERP组(n=42) 1(2.38) 1(2.38) 0 0 2(4.76) PKRP组(n=42) 2(4.76) 1(2.38) 2(4.76) 1(2.38) 6(14.29) χ2 0.516 1.016 - - 5.026 P值 0.772 0.602 0.247 0.500 0.081 注：“—”为Fisher精确概率法。
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表 3 2组手术前后IPSS评分、前列腺体积比较
X±S 组别 IPSS评分/分 前列腺体积/mL 术前 术后6个月 术前 术后6个月 TVERP组(n=42) 24.52±1.85 5.29±0.891) 52.48±4.55 10.93±2.111) PKRP组(n=42) 24.06±1.22 6.08±1.361) 51.96±5.11 21.25±3.481) t 1.345 3.150 0.493 16.434 P值 0.182 0.002 0.624 ＜0.001 与本组术前比较，1)P＜0.05。
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表 4 2组手术前后Qmax、PVR比较
X±S 组别 Qmax/(mL·s-1) PVR/mL 术前 术后6个月 术前 术后6个月 TVERP组(n=42) 5.19±0.89 19.85±1.561) 130.22±18.35 12.96±2.581) PKRP组(n=42) 5.34±0.75 16.71±1.381) 128.09±20.47 20.33±4.121) t 0.835 9.770 0.502 9.825 P值 0.406 ＜0.001 0.617 ＜0.001 与本组术前比较，1)P＜0.05。
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表 5 2组手术前后IIEF-5评分及性生活频率比较
X±S 组别 IIEF-5评分/分 性生活频率/(次·月-1) 术前 术后6个月 术前 术后6个月 TVERP组(n=42) 10.09±1.25 16.69±2.651) 2.96±0.52 4.52±0.821) PKRP组(n=42) 10.32±1.95 15.24±2.271) 2.82±0.56 4.02±0.751) t 0.644 2.693 1.187 2.916 P值 0.522 0.009 0.239 0.005 与本组术前比较，1)P＜0.05。
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