Comparison of clinical efficiency and safety between transurethral bipolar plasma kinetic resection of the prostate and transurethral bipolar plasma kinetic enucleation and resection of the prostate for benign prostatic hyperplasia in the plateau area
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摘要: 目的 比较经尿道等离子前列腺电切术与经尿道等离子前列腺剜除术联合电切术在高原地区对藏族同胞良性前列腺增生(BPH)的临床疗效及安全性。方法 收集2021年1月—2022年12月于拉萨市人民医院就诊的BPH患者，入组符合条件的60例患者。随机分入单纯前列腺电切术组(电切组)和前列腺剜除术联合电切术组(联合组)，每组30例。收集围手术期资料包括年龄、前列腺体积、前列腺特异性抗原(PSA)水平、国际前列腺症状(IPSS)评分、最大尿流率(Qmax)、ECOG评分、手术时间、住院时间、留置尿管时间、中叶突出程度、血红蛋白下降程度、术后并发症情况等。在术后1、3、6个月时进行随访，包括并发症、尿控恢复情况、术后IPSS评分及术后PSA评分。结果 电切组和联合组在患者年龄、前列腺体积、术前IPSS评分、Qmax、ECOG评分、中叶突出程度、血红蛋白下降程度、术前PSA水平、手术时间、术后并发症、术后尿控方面比较差异无统计学意义；在住院时间及导尿管留置时间上，电切组较联合组略有优势；随访方面，2组术后IPSS评分及改善程度差异无统计学意义，而联合组PSA在术后1个月时有一定优势，但在后续随访中2组差异无统计学意义。结论 经尿道等离子前列腺剜除术联合电切术在临床疗效及安全性方面不劣于被视为金标准的经尿道等离子前列腺电切术。且该术式不需另购器械，更易学习掌握，适宜在西藏高原地区和边远基层地区大力推广。
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关键词:
- 高原地区 /
- 经尿道等离子前列腺剜术除联合等离子电切术 /
- 良性前列腺增生
Abstract: Objective To compare the clinical efficiency and safety between transurethral bipolar plasma kinetic resection of the prostate (TURP) and transurethral bipolar plasma kinetic enucleation and resection of the prostate (TUERP) for Tibetan with benign prostatic hyperplasia (BPH) in the plateau area.Methods From January 2021 to December 2022, 60 eligible BPH patients were prospectively studied. They were divided into resection group and combination group randomly. Perioperative information, including age, prostate volume, prostate specific antigen(PSA), International Prostate Symptom Score(IPSS), maximum flow rate(Qmax), the Eastern Cooperative Oncology Group(ECOG) scores, operation time, hospitalization time, postoperative catheter retention time, intravesical prostatic protrusion(IPP), decline of hemoglobin, and complication, were collected. Complication, continence, postoperative IPSS and PSA were followed up at postoperative 1, 3, and 6 months.Results There was no significant difference between two groups in age, prostate volume, preoperative IPSS, ECOG scores, IPP, Qmax, decline of hemoglobin, preoperative PSA, operation time, complication, or continence. Resection group had some advantages in hospitalization time and postoperative catheter retention time. There was no significant difference in postoperative IPSS or its improvement. Combination group had some advantages in postoperative PSA one month after operation, while there was no difference in other follow-ups.Conclusion TUERP could compare with TURP on the clinical efficiency and safety. TUERP should be promoted in the plateau and remote area for its easy learning and free of extra equipment. -
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表 1 2组患者基线资料比较
X±S 项目 电切组(30例) 联合组(30例) P值 年龄/岁 65.47±7.83 69.13±8.34 0.084 前列腺体积/mL 77.30±24.30 67.62±22.39 0.114 术前IPSS评分 17.47±3.89 16.83±3.63 0.517 ECOG评分 0.17±0.38 0.07±0.25 0.235 中叶突出/mm 3.73±4.91 3.37±4.27 0.759 血红蛋白下降值/(g/L) 7.80±11.67 8.53±9.24 0.788 术前PSA/(ng/mL) 6.55±6.26 7.44±15.26 0.769 Qmax/(mL/s) 16.43±2.73 15.12±2.62 0.062 
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表 2 2组患者围术期资料比较
X±S 指标 电切组(30例) 联合组(30例) P值 手术用时/min 119.43±49.65 112.87±42.89 0.586 住院时间/d 6.77±2.10 8.07±2.53 0.034 拔管时间/d 5.93±2.27 8.57±5.81 0.020 尿失禁/例(%) 4(13.33) 2(6.67) 0.671
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表 3 2组患者IPSS评分及PSA比较
X±S 指标 电切组 联合组 P值 术后1个月 IPSS评分/分 6.77±2.47 6.07±1.86 0.22 PSA/(ng/mL) 0.94±0.84 0.54±0.69 0.049 IPSS评分改善/% 10.70±4.49 10.77±3.95 0.951 术后3个月 IPSS评分/分 4.83±1.15 4.73±0.91 0.709 PSA/(ng/mL) 0.50±0.55 0.34±0.33 0.164 IPSS评分改善/% 12.63±3.94 12.10±3.75 0.593 术后6个月 IPSS评分/分 4.87±1.14 4.60±1.04 0.346 PSA/(ng/mL) 0.38±0.43 0.27±0.34 0.293 IPSS评分改善/% 12.60±4.01 12.23±3.74 0.716
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