经尿道前列腺双极剜除术治疗症状性BPH的学习曲线研究(附100例报告)

熊玮; 冉清; 窦科; 陈放; 杜杨春; 孙明菡

经尿道前列腺双极剜除术治疗症状性BPH的学习曲线研究(附100例报告)

- 1. 四川省医学科学院, 四川省人民医院器官移植中心(泌尿三区)(成都, 610072);
- 2. 四川省人民医院超声医学科
基金项目:
四川省卫生厅科研基金资助项目（编号110165）

详细信息

通讯作者: 冉清,E-mail:ranqinghappy@126.com

中图分类号: R697

收稿日期: 2012-03-14

The bipolar transurethral enucleation and resection of the prostate in saline on symptomatic benign prostate hyperplasia: the learning curve from the first 100 consecutive patients

- 1. Department of Urology and Transplantation, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China;
- 2. Department of Ultrasonic Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital

More Information

Corresponding author: RAN Qing, E-mail: ranqinghappy@126.com

Received Date: 14 March 2012

摘要

摘要: 目的：总结连续实施经尿道前列腺双极剜除术治疗症状性BPH的临床安全性、疗效及学习曲线。方法：回顾性分析自2010年1月~2011年1月行经尿道前列腺双极剜除术治疗100例症状性BPH患者围手术期及随访资料，以中转为普通双极TURP比例剜除、剜除效率等指标评估学习曲线。结果：共83例患者完成经尿道前列腺双极剜除术，无中转开放手术。术前前列腺体积（74.8±27.05） ml，血红蛋白（131.72±8.01） g/L，IPSS评分（25.37±3.55）分，QOL （4.33±0.91）分，术前最大尿流率（Q_max）（6.54±2.95） ml/s，手术时间（117.5±37.22） min，术后3天血红蛋白（125.03±6.64） g/ml，术后留置尿管时间（3.3±1.9） d，术前与术后血清钠无明显变化。6个月后剩余前列腺体积（35.29±17.57） ml，Q_max（21.34±4.09） ml/s，IPSS评分（9.66±2.64）分，QOL （2.31±0.92）分。术后1个月内压力性尿失禁8例，均于术后3个月恢复；尿道外口狭窄发生3例，无后尿道及球部尿道狭窄发生，无膀胱颈挛缩发生。学习曲线中，Q_max、IPSS和QOL评分随手术例次增加无明显差异，但中转为普通双极TURP在经历30例后明显减少，剜除效率随手术例数累积明显提高，约50例次后处于平台期。结论：经尿道前列腺双极剜除术可安全用于症状性BPH的治疗，具有良好的临床疗效。其学习曲线在经历30例后可安全实施，50例后技术逐渐成熟并进入平台期。
- 良性前列腺增生 /
- 前列腺摘除术 /
- 学习曲线
Abstract: Objective: To investigate the efficacy, safety and short-term outcome of bipolar transurethral enucleation and resection of the prostate on prostatic adenomas, and elucidate the learning curve of this procedure.Method: We retrospectively reviewed data on 100 consecutive patients who had undergone bipolar transurethral enucleation and resection of the prostate for prostatic adenoma. All patients were evaluated preoperatively and at a follow-up interval 1, 3 and 6 months based on the peak urinary flow rate(Q_max), post-void residual urine, and International Prostate Symptom Score and quality of life index measurement. To assess the impact of the learning curve on postoperative outcome patients were divided into group 1-patients 1 to 10, group 2-11 to 20 and group 3-21 to 30. The relationship between the number of procedures and treatment efficacy was analyzed. The learning curve with regard to efficiency for tissue enucleation was assessed. The effect of the learning curve on efficiency of enucleation and resection y was studied.Result: The 83 patients were successfully operated under bipolar transurethral enucleation and resection of the prostate. No operation was converted to open surgery. The mean preoperative prostate volume was (74.8±27.05)ml, the mean IPSS was (25.37±3.55) and QOL were (4.33±0.91), and Q_max were (6.54±2.95)ml/s. The mean operative time was (117.5±37.22) minutes. The mean indwelling catheterization was (3.3±1.9) days. The serum sodium did not change significantly, while the serum hemoglobin level reduced mildly but no blood transfusion cases. After 6 month, the Q_max was (21.34±4.09)ml/s, IPSS was (9.66±2.64) and QOL were (2.31±0.92) with residual prostate volume was (35.29±17.57)ml. Complications included short-term stress urinary incontinence in 8 cases and postoperative external meatus stricture in 3 cases. Bladder injury during resection was observed in 2 cases. The conversion ratio to conventional bipolar TURP reduced after 30 cases and the efficiency of enucleation and resection increased significantly as experience increased after 50 cases. However, the ratio of improvement in the preoperative-to-postoperative Q_max, IPSS and QOL index did not change significantly as experience increased.Conclusion: The bipolar transurethral enucleation and resection of the prostate is an effective treatment option for benign prostatic adenoma, providing good treatment efficacy and minimal bleeding. The bipolar TUERP is a safe and reproducible procedure even if the surgeon has minimal experience. While gaining experience, bipolar TUERP can be converted to conventional bipolar TURP with no harm to the patients.
- benign prostate hyperplasia /
- prostatectomy /
- learning curve

HTML全文

参考文献(17)

[1]	郑少波,刘春晓,徐亚文. 前列腺腔内逆行剥离法在经尿道前列腺汽化切除术中的应用[J]. 第一军医大学学报, 2005, 25(6):734-736.
[2]	卞军,刘春晓,郑少波,等. 经尿道前列腺等离子腔内剜除术与切除术治疗前列腺增生的临床对照研究[J]. 南方医科大学学报, 2008, 28(5):742-745.
[3]	刘春晓. 经尿道前列腺腔内剜除术[J]. 中华腔镜泌尿外科杂志(电子版), 2009, 3(1):90.
[4]	刘晟,仇明,江道振,等. 微创手术学习曲线的新概念与临床意义[J]. 中国微创外科杂志, 2008, 8(1):5-6.
[5]	SECIN F P, SAVAGE C, ABBOU C, et al. The learning curve for laparoscopic radical prostatectomy:an international multicenter study[J]. J Urol, 2010, 184:2291-2296.
[6]	BAE J, OH S J, PAICK J S. The Iearning curve for holmium laser enucleation of the prostate:A single-center experience[J]. Korean Journal of Urology, 2010, 51:688-693.
[7]	GILLING P J, KENNETT K, DAS A K, et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation:an update on the early clinical experience[J]. J Endourol, 1998, 12:457-459.
[8]	HOCHREITER W W, THALMANN G N, BURKHARD F C, et al. Holmium laser enucleation of the prostate combined with electrocautery resection:the mushroom technique[J]. J Urol, 2002, 168:1470-1474.
[9]	EL-HAKIM A, ELHILALI M M. Holmium laser enucleation of the prostate can be taught:the first learning experience[J]. BJU Int, 2002, 90:863-869.
[10]	刘齐贵. 钬激光前列腺剜除术[J]. 中华男科学杂志, 2010, 168(8):675-678.
[11]	KRAMBECK A E, HANDA S E, LINGEMAN J E. Holmium laser enucleation of the prostate for prostates larger than 175 grams[J]. J Endourol, 2010, 24:433-437.
[12]	BACH T, NETSCH C, HAECKER A, et al. Thulium:YAG laser enucleation (Vapo Enucleation) of the prostate:safety and durability during intermediate-term follow-up[J]. World Journal of Urology, 2010, 28:39-43.
[13]	RUSZAT R, SEITZ M, WYLER S F, et al. GreenLight laser vaporization of the prostate:single-center experience and long-term results after 500 procedures[J]. Eur Urol, 2008, 54:893-901.
[14]	SEKI N, MOCHIDA O, KINUKAWA N, et al. Holmium laser enucleation for prostatic adenoma:analysis of learning curve over the course of 70 consecutive cases[J]. J Urol, 2003, 170:1847-1850.
[15]	SHAH H N, MAHAJAN A P, SODHA H S, et al. Prospective evaluation of the learning curve for holmium laser enucleation of the prostate[J]. J Urol, 2007, 177:1468-1474.
[16]	PLACER J, GELABERT-MAS A, VALLMANYA F, et al. Holmium laser enucleation of prostate:outcome and complications of self-taught learning curve[J]. Urology, 2009, 73:1042-1048.
[17]	DUSING M W, KRAMBECK A E, TERRY C, et al. Holmium laser enucleation of the prostate:efficiency gained by experience and operative technique[J]. J Urol, 2010, 184:635-640.