CAJ | 학술논문

目的探讨经皮膀胱穿刺造瘘在经尿道前列腺等离子电切术(PKRP)治疗高危高龄大体积前列腺增生中的临床价值.方法 2012年1月～ 2013年6月35例行前列腺电切的高龄高危前列腺增生患者随机数字表法分为造瘘组和非造瘘组,分别采用经皮膀胱造瘘+ PKRP和标准PKRP.监测术中血压(MBP)、心率(HR)、中心静脉压(CVP),检测术前、术后血酸碱度(pH)、Na+、K+、Cl-、阴离子间隙(BE),记录手术时间、术中出血量、切除前列腺质量、术后尿色转清时间,评估手术前后的IPSS、最大尿流率、残余尿量(PVR)和生活质量评分(QOL).结果非造瘘组术中MBP、CVP较术前差异有统计学意义(P＜0.05),造瘘组术中MBP、HR、CVP较术前差异无统计学意义.非造瘘组Na+、pH、BE术前术后差异有统计学意义(P＜0.05),造瘘组Na+、K+、Cl-、pH、BE术前术后差异无统计学意义,提示造瘘组较非造瘘组更安全.造瘘组较非造瘘组手术时间更长、前列腺切除质量更多,术后尿色转清时间更短,最大尿流率、IPSS改善更佳,提示造瘘组较非造瘘组治疗效果更佳.结论经皮膀胱造瘘安全、微创,联合PKRP治疗高龄高危BPH提高了手术的安全性,增加了手术的治疗效果,值得临床应用推广.
목적 탐토경피방광천자조루재경뇨도전렬선등리자전절술(PKRP)치료고위고령대체적전렬선증생중적림상개치.방법 2012년1월～ 2013년6월35례행전렬선전절적고령고위전렬선증생환자수궤수자표법분위조루조화비조루조,분별채용경피방광조루+ PKRP화표준PKRP.감측술중혈압(MBP)、심솔(HR)、중심정맥압(CVP),검측술전、술후혈산감도(pH)、Na+、K+、Cl-、음리자간극(BE),기록수술시간、술중출혈량、절제전렬선질량、술후뇨색전청시간,평고수술전후적IPSS、최대뇨류솔、잔여뇨량(PVR)화생활질량평분(QOL).결과 비조루조술중MBP、CVP교술전차이유통계학의의(P＜0.05),조루조술중MBP、HR、CVP교술전차이무통계학의의.비조루조Na+、pH、BE술전술후차이유통계학의의(P＜0.05),조루조Na+、K+、Cl-、pH、BE술전술후차이무통계학의의,제시조루조교비조루조경안전.조루조교비조루조수술시간경장、전렬선절제질량경다,술후뇨색전청시간경단,최대뇨류솔、IPSS개선경가,제시조루조교비조루조치료효과경가.결론 경피방광조루안전、미창,연합PKRP치료고령고위BPH제고료수술적안전성,증가료수술적치료효과,치득림상응용추엄.
Objectives To investigate the safety and efficacy of combination regimen of PKRP and cystostomy for BPH patients at high risk.Methods 35 BPH patients at high risk were randomly divided into two groups:Cystostomy group and non-cystostomy group.The patients in the non-cystostomy group underwent PKRP,The patients in the cystostomy group received combination regimen of PKRP and cystostomy.Mean blood pressure (MBP),heart rate(HR),central venous pressure(CVP) were monitored during operation.Serum pH,Na +,K +,Cl-,anion gap(BE) were determined before and after operation.The operation time,intraoperative bleeding volume,resection of the prostate quality,postoperative urine turned clear time were recorded.IPSS,maximum flow rate (Qmax),postvoid residual volume (PVR),life quality score (QOL) was evaluated before and after operation.Results MBP,HR,CVP,Na +,K +,Cl-,pH,BE did not change significantly during and after operation in the cystostomy group.MBP,CVP,Na +,pH,BE change significantly in the non-cystostomy group(P ＜ 0.05).Compared with the non-cystostomy group,the cystostomy group underwent longer duration of operation (P ＜ 0.05),quantity of resected tissue more(P ＜0.05),postoperative urine turned clear time shorter(P ＜ 0.05),the Qmax and IPSS were more improved.Conclusions Percutaneous cystostomy safe,minimally invasive,combined with PKRP in the treatment of high-risk BPH improves the operation safety,increase the operation therapeutic effect,is worthy of clinical application and promotion.