经尿道等离子电切前列腺的临床应用.DOCVIP

临床医学论文-经尿道等离子电切前列腺的临床应用关键词：良性前列腺增生；经尿道双极等离子体前列腺切除；TUR? ????【摘要】?目的?评价经尿道双极等离子体前列腺切除（TUPKP）的安全性和有效性。方法?87例良性前列腺增生（BPH）患者，年龄52～85岁，平均70岁。采用等离子体切割技术行经尿道前列腺切除，切割方法采用Alcock或Flocks法。术后随访3个月～1年，比较术后最大尿流率（Qmax）和IPSS评分恢复情况。结果?手术时间30～90min，切割获取前列腺组织平均50g，平均出血150ml。术后持续膀胱冲洗时间0.5～1天，留置导尿管时间3～5天，平均住院时间6天。术后3个月Qmax平均恢复至每秒24.5ml，IPSS评分自平均24分降至6分。结论?初步结果显示，TUPKP治疗前列腺增生症是安全可靠的，与经尿道膀胱肿瘤电切术（TURBt）比较，具有安全性高、适应证广、出血少、损伤小、恢复快等优点。 ????【关键词】?良性前列腺增生；经尿道双极等离子体前列腺切除；TUR ????Clinical?application?of?isoionic-electric?transurethral?prostatectomg ????【Abstract】?Objective?To?assess?the?efficacy?and?the?safety?of?transurethral?bipolar?plasma?kinetic?prostatectomy?（TUPKP）.Methods?Eighty?six?patients?（mean?age70;range52～85years）?with?benign?prostatic?hyperplasia（BPH）?underwent?TUPKP.The?methods?of?the?operation?were?Alcock?or?Flocks.?After?operation，the?patients?were?followed?up?at?3?months?to?1?year?and?measured?the?International?Prostate?Symptom?Score?（IPSS）?and?maximum?urinary?flow?rate.?Results?The?operative?time?was?30?minutes?to?90?minutes.?The?average?weight?of?the?prostate?tissue?cut?of?in?the?operation?was?55g.?The?average?blood?loss?was?150ml.?The?time?of?postoperative?continuous?bladder?irrigation?was?0.5?day?to?1?day.The?catheterization?time?was?3?days?to?5?days.?The?average?post?operative?hospital?stay?was?6?days.?The?mean?peak?flow?rate?increasedat?least?24.5?ml/s?and?the?IPSS?decreased?from?24?to?6?at?3?months.Conclusion?The?preliminary?results?with?TUPKP?suggest?that?it?is?a?useful?and?safe?endoscopic?device.?It?appears?to?be?an?effective?treatment?for?BPH.?This?pilot?series?permits?acomparative?study?with?TURP?to?assess?the?benefits?for?patients?and?the?health?care?system. ????【Key?words】?BPH；TUPKP；TURP ?? ????1?资料与方法 ????1.1?一般资料?本组BPH患者87例，年龄52～85岁，平均70岁，病程2个月～10年，IPSS平均24分，Qmax15ml/s，均具有前列腺切除的手术指征。通过影像学、PSA检查及活检病理排除前列腺癌，前列腺重量25～140g，平均72g，超过50g者占73.6%（64/87）。并发膀胱移行细胞癌T2aG?11例，膀胱结石8例，前列腺出血11例，不同程度肾后性肾功能不全6例，糖尿病10例，脑血管病后遗症11例，窦性心动过缓4例，其中2例术前安装起搏器。 ????1.2?手术方法?采用连续硬膜外或硬脊