CAJ | 학술논문

目的对比经尿道前列腺汽化电切术(Transurethral Vaporization Resection of the Prostate, TUVRP)、经尿道前列腺等离子体双极电切术(Bipolar Plasmakinetic Transurethral Resection of Prostate, PKRP)以及经直肠高强度聚焦超声(Transrectal High-intensity Focused Ultrasound, HIFU)前列腺消融术治疗前列腺增生症(benign prostatic hyperplasia,BPH)的临床疗效.方法将471例前列腺增生患者按术式不同分为三组,其中TUVRP组102例,PKRP组225例,HIFI组144例,回顾分析并比较各组术后一般情况及并发症等,并对相关指标进行统计学分析.结果3组病人术前一般情况比较无统计学差异(P>0.05).HIFU组的术后相关指标及并发症与TUVRP组和PKRP组差异有显著性(P<0.05),HIFU组的手术时间、持续膀胱冲洗时间、术后留置尿管时间、住院时间均短于TUVRP组和PKRP组,且术中出血量、术中输血量以及并发症均明显低于TUVRP组和PKRP组.TUVRP组和PKRP组在手术时间、持续膀胱冲洗时间、TUR综合征发生率的差异有统计学意义(P<0.05),即PKRP的手术时间和持续膀胱冲洗时间较TUVRP短,TUR综合征发生率较低.而TUVRP组和PKRP组在术中出血量、术后留置尿管时间、住院时间、术中输血、费用、勃起功能障碍、逆行射精、二次手术、尿道狭窄、继发出血、膀胱颈挛缩差异无统计学意义(P>0.05).各组术后主、客观症状均较术前明显改善,差异有统计学意义(P<0.05).而HIFU组术后3个月时与术后2年时的主、客观指标比较,发现两者有显著性差异(P<0.05),术后2年较术后3个月主、客观症状进一步改善,但较TUVRP组和PKRP组的效果差.结论 TUVRP、PKRP和HIFU均是治疗BPH的有效方法, TUVRP与PKRP两者疗效相似,但PKRP的安全性较TUVRP高.相对而言,经直肠HIFU前列腺消融术是三者中治疗BP H最安全、痛苦最小、恢复最快、并发症最少的方法,缺点是有效性不如另外两种术式. 目的對比經尿道前列腺汽化電切術(Transurethral Vaporization Resection of the Prostate, TUVRP)、經尿道前列腺等離子體雙極電切術(Bipolar Plasmakinetic Transurethral Resection of Prostate, PKRP)以及經直腸高彊度聚焦超聲(Transrectal High-intensity Focused Ultrasound, HIFU)前列腺消融術治療前列腺增生癥(benign prostatic hyperplasia,BPH)的臨床療效.方法將471例前列腺增生患者按術式不同分為三組,其中TUVRP組102例,PKRP組225例,HIFI組144例,迴顧分析併比較各組術後一般情況及併髮癥等,併對相關指標進行統計學分析.結果3組病人術前一般情況比較無統計學差異(P>0.05).HIFU組的術後相關指標及併髮癥與TUVRP組和PKRP組差異有顯著性(P<0.05),HIFU組的手術時間、持續膀胱遲洗時間、術後留置尿管時間、住院時間均短于TUVRP組和PKRP組,且術中齣血量、術中輸血量以及併髮癥均明顯低于TUVRP組和PKRP組.TUVRP組和PKRP組在手術時間、持續膀胱遲洗時間、TUR綜閤徵髮生率的差異有統計學意義(P<0.05),即PKRP的手術時間和持續膀胱遲洗時間較TUVRP短,TUR綜閤徵髮生率較低.而TUVRP組和PKRP組在術中齣血量、術後留置尿管時間、住院時間、術中輸血、費用、勃起功能障礙、逆行射精、二次手術、尿道狹窄、繼髮齣血、膀胱頸攣縮差異無統計學意義(P>0.05).各組術後主、客觀癥狀均較術前明顯改善,差異有統計學意義(P<0.05).而HIFU組術後3箇月時與術後2年時的主、客觀指標比較,髮現兩者有顯著性差異(P<0.05),術後2年較術後3箇月主、客觀癥狀進一步改善,但較TUVRP組和PKRP組的效果差.結論 TUVRP、PKRP和HIFU均是治療BPH的有效方法, TUVRP與PKRP兩者療效相似,但PKRP的安全性較TUVRP高.相對而言,經直腸HIFU前列腺消融術是三者中治療BP H最安全、痛苦最小、恢複最快、併髮癥最少的方法,缺點是有效性不如另外兩種術式.
목적대비경뇨도전렬선기화전절술(Transurethral Vaporization Resection of the Prostate, TUVRP)、경뇨도전렬선등리자체쌍겁전절술(Bipolar Plasmakinetic Transurethral Resection of Prostate, PKRP)이급경직장고강도취초초성(Transrectal High-intensity Focused Ultrasound, HIFU)전렬선소융술치료전렬선증생증(benign prostatic hyperplasia,BPH)적림상료효.방법장471례전렬선증생환자안술식불동분위삼조,기중TUVRP조102례,PKRP조225례,HIFI조144례,회고분석병비교각조술후일반정황급병발증등,병대상관지표진행통계학분석.결과3조병인술전일반정황비교무통계학차이(P>0.05).HIFU조적술후상관지표급병발증여TUVRP조화PKRP조차이유현저성(P<0.05),HIFU조적수술시간、지속방광충세시간、술후류치뇨관시간、주원시간균단우TUVRP조화PKRP조,차술중출혈량、술중수혈량이급병발증균명현저우TUVRP조화PKRP조.TUVRP조화PKRP조재수술시간、지속방광충세시간、TUR종합정발생솔적차이유통계학의의(P<0.05),즉PKRP적수술시간화지속방광충세시간교TUVRP단,TUR종합정발생솔교저.이TUVRP조화PKRP조재술중출혈량、술후류치뇨관시간、주원시간、술중수혈、비용、발기공능장애、역행사정、이차수술、뇨도협착、계발출혈、방광경련축차이무통계학의의(P>0.05).각조술후주、객관증상균교술전명현개선,차이유통계학의의(P<0.05).이HIFU조술후3개월시여술후2년시적주、객관지표비교,발현량자유현저성차이(P<0.05),술후2년교술후3개월주、객관증상진일보개선,단교TUVRP조화PKRP조적효과차.결론 TUVRP、PKRP화HIFU균시치료BPH적유효방법, TUVRP여PKRP량자료효상사,단PKRP적안전성교TUVRP고.상대이언,경직장HIFU전렬선소융술시삼자중치료BP H최안전、통고최소、회복최쾌、병발증최소적방법,결점시유효성불여령외량충술식.
@@@@Objective To comparatively analze the clinical efficacy of transurethral vaporization resection of the prostate (TUVRP), bipolar plasmakinetic transurethral resection of prostate (PKRP) and high intensity focused ultrasound(HIFI) in the treatment of benign prostatic hyperplasia. Methods Based on different operation modes , 471 cases of BPH were divided into three groups such as TUVRP group(n=102), PKRPgroup(n=225), HIFUgroup (n=144). And the therapeutic effects were evaluated. Results There was no significant differences in pretherapy parameters among three groups (P>0.05). HIFI group was different from TUVRP and PKRP group in post-operative complication and related indicator. (P<0.05). The operative time, continuous bladder irrigating time, time of indwelling urinary catheter, hospital stay, amount of bleeding, amount of blood transfusion, the occurrence of complications were shorter than those in TUVRP and PKRP group.There were significant differences between TUVRP and PKRP group in operative time, continuous bladder irrigating time, incidence of TURS. (P<0.05)There were no significant differences between TUVRP and PKRP group in amount of bleeding, time of indwelling urinary catheter, hospital stay, amount of blood transfusion,spend, incidence of erectile dysfunction, incidence of re-operation, incidence of urethral stricture, incidence of secondary bleeding, incidence of bladder neck contracture. (P>0.05) Qmax, RUV, PV, IPSS, QOL were significantly improved in each group after the procedure(P<0.05). The subjective and objective symptoms further improved after 2 years in HIFI group,but was still lower than that of TUVRP and PKRP group. Conclusion All three methods are effective for treatment of BPH. TUVRP was similar to PKRP in efficacy,but the security of PKRP was higher than that of TUVRP. Generaly,security of transrectal high intensity focused ultrasound for treatment of BPH was better than that of TUVRP and PKRP group.