目的 探讨和总结腔内治疗技术在老年高危良性前列腺增生(BPH)患者中应用的安全性、有效性和治疗经验. 方法 采用腔内治疗技术,包括经尿道等离子体前列腺电切术(PKRP)和经尿道前列腺电切术(TURP)治疗老年高危BPH患者202例,其中TURP组90例,PKRP组112组. 结果 所有患者术后随访3~24个月.TURP组国际前列腺症状评分(IPSS)、生活质量评分(QOL)和残余尿量由术前的(27.8±2.5)分、(5.5±1.1)分和(95.0±18.0) ml下降至术后的(6.3±1.2)分、(1.4±o.2)分和(24.2±2.8) ml,而最大尿流率(Qmax)由术前的(5.4±2.0)ml/s上升至术后的(18.5±1.4) ml/s(t=19.68、13.72、27.75、20.10,均P<0.05);PKRP组患者IPSS由术前(27.9±2.3)分下降至(6.4±2.5)分,QOL由(5.5±0.4)分减少至(1.5±0.5)分,残余尿量由(150.0±26.0) ml下降至(25.0± 4.0)ml,Qmax由(7.0±2.3) ml/s上升至(19.0±2.3) ml/s(t=20.12、15.67、28.34、20.23,均P<0.05),两组治疗后各指标差异无统计学意义(t=0.35、1.79、1.61、1.81,均P>0.05).PKRP组术后并发症发生率7例(6.25%),较TURP组20例(22.2%)少(x2=10.99,P<0.05). 结论 对年龄70岁及以上且伴有重要脏器并发症的老年高危BPH患者,经腔内技术,尤其是PKRP治疗是安全有效的;个体化的手术方案、充分的术前准备及严格的术中、术后监护和护理是手术成功的关键.
Objective To evaluate the safety and effectiveness of endourological techniques in the treatment of benign prostate hyperplasia (BPH) in elderly high-risk patients.Methods A total of 202 BHP patients over 70 years old were treated with endourological techniques and followed up for 3-24 months.Patients were divided into transurethral resection of the prostate(TURP) group (n=90)and transurethral plasmakinetic resection of the prostate(PKRP) group (n =112).Results Compared with pre-treatment,the scores of IPSS and quality of life (QOL),residual urine volume and Qmax were improved in the TURP group after treatment [(6.3±1.2) vs.(27.8±2.5),(1.0±0.4)vs.(5.5±1.1),(18.0±2.8) ml vs.(95.0±18.0) ml,(17.5±1.4) ml/s vs.(5.4±2.0) ml/s,respectively,all P<0.05].Compared with before treatment,the scores of IPSS and QOL,residual urine volume and Qmax were also improved in the PKRP group after treatment [(8.4 ± 2.5) vs.(27.9±2.3),(1.0±0.4) vs.(1.5±0.5),(25±4) mlvs.(150±26) ml,(19±2.3) ml/svs.(7.0±2.3) ml/s,respectively,all P<0.05].There were no significant differences in IPSS,QOL,Qmax and RUV between the two groups after treatment (P>0.05),but the complication incidence was less in PKRP group than in TURP group (6.25% vs.22.2%,x2 =10.99,P<0.05).Conclusions PKRP is a safe and effective therapy for elderly high risk patients with BPH.The individual treatment,intensive monitoring and adjustment before operation,and skilled manipulation are the key points to the successful operation.