CAJ | 학술논문

目的：对比经尿道前列腺双极等离子电切术（transurethral bipolar plasmakinetic re‐section of the prostate ，TUPKRP）与高功率选择性前列腺绿激光汽化术（green laser photoselective vaporization ，PVP）治疗高危高龄良性前列腺增生（benign prostatic hyperplasia ，BPH）患者的临床疗效和安全性。方法68例高危高龄的BPH患者为研究对象，其中33例行TUPKRP治疗，35例行PVP治疗。比较两组术前和术后6个月的国际前列腺症状评分（international prostate symp‐tom score ，IPSS）、生活质量评分（quality of life ，QOL）、最大尿流率（maximum flow rate ，Qmax）、残余尿（residual urine ，RU V ）以及手术时间、术中出血量、术后留置尿管时间、术后住院时间及远期并发症等情况。结果两组患者术后的IPSS评分、QOL评分、Qmax、RUV均较术前取得了明显的改善，在TUPKRP组，术后6个月的IPSS评分由（22．0±5．5）分降至（4．0 ± 2．1）分，Qmax由术前的（7．5 ± 2．7）ml／s升至（18．5 ± 2．7）ml／s ，RUV由术前的（100．1±32．4）ml降至（26．3±22．4）ml；在PVP组，IP‐SS评分由（21．0 ± 7．5）分降至（4．0 ± 2．5）分，Qmax由术前的（7．4 ± 2．8）ml／s升至（18．4±3．2）ml／s ，RUV由术前的（100．8±31．2）ml降至（25．8±23．2）ml ，两组间差异无统计学意义（P＞0．05）。但PVP组的术中出血量、术后留置尿管时间及术后住院时间均优于TUPKRP组（P＜0．05），术后并发症无明显差异。PVP组手术时间较TUPKRP组长（P＜0．05）。结论两种手术方式对于高危高龄BPH患者在良好控制内科疾病的情况下均有明确的临床疗效，但PV P术中出血少、术后住院时间更短，较TUPKRP更具优势、更安全。
목적：대비경뇨도전렬선쌍겁등리자전절술（transurethral bipolar plasmakinetic re‐section of the prostate ，TUPKRP）여고공솔선택성전렬선록격광기화술（green laser photoselective vaporization ，PVP）치료고위고령량성전렬선증생（benign prostatic hyperplasia ，BPH）환자적림상료효화안전성。방법68례고위고령적BPH환자위연구대상，기중33례행TUPKRP치료，35례행PVP치료。비교량조술전화술후6개월적국제전렬선증상평분（international prostate symp‐tom score ，IPSS）、생활질량평분（quality of life ，QOL）、최대뇨류솔（maximum flow rate ，Qmax）、잔여뇨（residual urine ，RU V ）이급수술시간、술중출혈량、술후류치뇨관시간、술후주원시간급원기병발증등정황。결과량조환자술후적IPSS평분、QOL평분、Qmax、RUV균교술전취득료명현적개선，재TUPKRP조，술후6개월적IPSS평분유（22．0±5．5）분강지（4．0 ± 2．1）분，Qmax유술전적（7．5 ± 2．7）ml／s승지（18．5 ± 2．7）ml／s ，RUV유술전적（100．1±32．4）ml강지（26．3±22．4）ml；재PVP조，IP‐SS평분유（21．0 ± 7．5）분강지（4．0 ± 2．5）분，Qmax유술전적（7．4 ± 2．8）ml／s승지（18．4±3．2）ml／s ，RUV유술전적（100．8±31．2）ml강지（25．8±23．2）ml ，량조간차이무통계학의의（P＞0．05）。단PVP조적술중출혈량、술후류치뇨관시간급술후주원시간균우우TUPKRP조（P＜0．05），술후병발증무명현차이。PVP조수술시간교TUPKRP조장（P＜0．05）。결론량충수술방식대우고위고령BPH환자재량호공제내과질병적정황하균유명학적림상료효，단PV P술중출혈소、술후주원시간경단，교TUPKRP경구우세、경안전。
Objective To compare the clinical effects and safety between transurethral bipolar plasmakinetic resection of the prostate (TUPKRP) and high‐power green laser photoselective vaporization (PVP) in eldly benign prostatic hyperplasia (BPH) men with high surgical risk . Methods 68 cases of BPH with at least one internal disease were divided into two groups : 33 cases in TUPKRP group and 35 cases in PVP group .The clinical data of all the patients were collected and compared between the TUPKRP group and PVP group ,including pre‐operation and six month after operation international prostate symptom score (IPSS) ,quality of life (QOL) ,urine flow rate (Qmax) ,residual urine (RUV) as well as operational time ,operative bleeding volume ,time of indwelling catheter after operation ,hospitalization time after operation and complications after operation . Results Two groups had significantly improved both in IPSS ,QOL ,Qmax and and also in RUV after the operation .The IPSS greatly changed from (22 .0 ± 5 .5 ) down to (4 .0 ± 2 .1 ) ; Qmax from (7 .5 ± 2 .7 )ml/s up to (18 .5 ± 2 .7)ml/s ;RUV from (100 .1 ± 32 .4)ml down to (26 .3 ± 22 .4)ml in TUPKRP six months after surgery .Meanwhile ,the IPSS greatly changed from (21 .0 ± 7 .5) down to (4 .0 ± 2 .5) ;Qmax from (7 .4 ± 2 .8)ml/s up to (18 .4 ± 3 .2)ml/s ;RUV from (100 .8 ± 31 .2)ml down to (25 .8 ± 23 .2)ml in PVP six months after operation .The difference between the two groups had no significance in statistics (P> 0 .05) .However ,there were significant difference between the two groups in the operative bleeding volume ,time of indwelling catheter after operation and hospitalization time after operation .PVP is superior to TUPKRP .Complications after operation showed no difference .The operation time of the PVP was longer than that of the TUPKRP . Conclusions For surgical treatment of eldly men with high surgical risk ,both TUPKRP and PVP are safe and effective to patients with sufficiently controlled internal disease .But considering less bleeding and hospitalization time ,PVP has more advantages in the treatment of high risk patients of BPH compared with TUPKRP .