CAJ | 학술논문

比较经尿道接触式激光前列腺切除术(TULP),经尿道电极汽化式前列腺切除术(TVP)和经尿道电汽化前列腺切除术(TUEVAP)对良性前列腺增生症(BPH)的治疗效果.把具有明显排尿困难等症状的患者随机分组,分别行TULP、TVP或TUEVAP,其中行TULP 388例,TVP203例,TUEVAP167例.这些患者都用国际前列腺症状评分(IPSS),最大尿流率(Qmax)和膀胱残余尿测定(PDV)等参数来评估.每组都用相同的参数评估了3个月,还有其它的一些参数如:血浆红细胞压积,血钠,手术持续时间,手术后留置导尿时间和副作用.对于TULP、TVP和TUEVAP组,3个月后国际前列腺症状评分分别从(28.6±3.8)到(10.2±4.3),从(29.4±5.2)到(9.6±4.8),和从(30±5)到(9.5±3.5),最大尿流率分别从(6.5±3)mL/s增加至(16.4±3.2)mL/s,从(7.6±3.9)mL/s增加至(16.7±3.8)mL/s,和从(6.5±3)mL/s增加至(17.5±4.5)mL/s(P＜0.01).比较术前和术后PVR有明显改进(P＜0.01).3组中术后主观和客观的症状改进与经尿道前列腺切除术(TURP)组比较无显著差异(P＞0.05).在TULP组中平均留置导尿时间(78.6±7.2)h比TVP组(28±4.6)h和TUEVAP组(24±3.8)h长.TULP组的术后血尿、急性睾丸炎和尿路刺激症状的发生率明显高于其他组,表明TUEVAP、TVP和TULP与治疗良性前列腺增生的金标准TURP具有同样的效果,但术后并发症明显少于TURP,其中TUEVAP操作简单,去除腺体量大,恢复快,近期疗效满意,有良好的应用前景.
비교경뇨도접촉식격광전렬선절제술(TULP),경뇨도전겁기화식전렬선절제술(TVP)화경뇨도전기화전렬선절제술(TUEVAP)대량성전렬선증생증(BPH)적치료효과.파구유명현배뇨곤난등증상적환자수궤분조,분별행TULP、TVP혹TUEVAP,기중행TULP 388례,TVP203례,TUEVAP167례.저사환자도용국제전렬선증상평분(IPSS),최대뇨류솔(Qmax)화방광잔여뇨측정(PDV)등삼수래평고.매조도용상동적삼수평고료3개월,환유기타적일사삼수여:혈장홍세포압적,혈납,수술지속시간,수술후류치도뇨시간화부작용.대우TULP、TVP화TUEVAP조,3개월후국제전렬선증상평분분별종(28.6±3.8)도(10.2±4.3),종(29.4±5.2)도(9.6±4.8),화종(30±5)도(9.5±3.5),최대뇨류솔분별종(6.5±3)mL/s증가지(16.4±3.2)mL/s,종(7.6±3.9)mL/s증가지(16.7±3.8)mL/s,화종(6.5±3)mL/s증가지(17.5±4.5)mL/s(P＜0.01).비교술전화술후PVR유명현개진(P＜0.01).3조중술후주관화객관적증상개진여경뇨도전렬선절제술(TURP)조비교무현저차이(P＞0.05).재TULP조중평균류치도뇨시간(78.6±7.2)h비TVP조(28±4.6)h화TUEVAP조(24±3.8)h장.TULP조적술후혈뇨、급성고환염화뇨로자격증상적발생솔명현고우기타조,표명TUEVAP、TVP화TULP여치료량성전렬선증생적금표준TURP구유동양적효과,단술후병발증명현소우TURP,기중TUEVAP조작간단,거제선체량대,회복쾌,근기료효만의,유량호적응용전경.
This paper compared the efficacy and complication among transurethral contact laserprostatectomy (TULP), transurethral vaporization prostatectomy (TVP), and a new operativetechnique of transurethral electrovaporization-ablation prostatectomy (TUEVAP) in the treatment ofmen with symptomatic benign prostatic hyperplasia (BPH). Patients with urinary tract symptomsfrom moderate to severe lower levels and evidence for obstruction were randomized to undergo TULP(Nd:YAG contact laser) or TVP (with ball-roller bar electrode) or TUEVAP (with a new operativetechnique and the Vapor Tome electrode). 388 patients were treated with TULP, 203 patients withTVP, and 167 patients with TUEVAP respectively. Patients with symptoms were assessed accordingto the international prostate symptoms score (IPSS), peak urinary flow rate (Qmax), and post-voidresidual urine volume (PVR). The same parameters were evaluated again in 3 months for everygroup. Other parameters included changes in serum hematocrit, sodium concentration, operativeduration, postoperative indwelling catheter time and incidence of side effects. For TULP, TVP andTUEVAP, IPSSs decreased from (28.6± 3.8) to (10.2 ± 4.3), from (29.4 ± 5.2) to (9.6 ±4.8), and from (30 ± 5) to (9.5 ± 3.5) respectively, and peak urinary flow rates increased from(6.5±3) mL/s to (16.4±3.2) mL/s, from (7.6±3.9) mL/s to (16.7±3.8) mL/s, and from(6.5±3) mL/s to (17.5±4.5) mL/s in 3 months, respectively (P＜0.01). When we comparedPVRpreoperatively with those postoperatively, the improvements were significant (P ＜ 0.01).Among the TULP, TVP, TUEVAP and TURP groups, the postoperative improvements insubjective and objective symptoms were not significantly different (P ＞0.05). The mean indwellingcatheter time in TULP group ((78.6±7.2) hours) was longer than that of other groups (TVPgroup: (28 ± 4.6) hours, TUEVAP group: (24 ± 3.8) hours). The postoperative hematuria, acuteepididymitis, and urinary tract symptoms were more usual in TULP group than in other groups,indicating that TUEVAP, TVP and TULP were as effective as "gold standard" TURP, butproduced significantly less postoperative morbidity than TURP. As TUEVAP yielded lest sideeffects, it might be recommended as a treatment for symptomatic BPH.