CAJ | 학술논문

目的：比较经尿道前列腺电切术（TURP）、双极等离子切除术（PKRP）及钬激光剜除术（HoLEP）三种术式并发症差异，初步探讨Clavien-Dindo分级对3种术式并发症标准化评价的应用价值。方法2010年1月至2013年12月在本院泌尿外科接受腔镜手术的前列腺增生患者625例按照术式分为3组：TURP（214例）、PKRP（207例）和HoLEP（204例），分别统计3组各项并发症差异并纳入Clavien-Dindo分级进行比较。结果3组患者一般资料比较差异无统计学意义（P>0.05），TURP组各项的并发症发生率总体上高于PKRP组和HoLEP组，其中电解质失平衡、术中大量失血、尿路刺激症状、尿路堵塞、前列腺电切综合征、术后勃起功能障碍3组间差异有统计学意义（P<0.05）。按照Clavien-Dindo分级，Ⅱ级并发症比较，TURP组显著高于PKRP组和HoLEP组（P<0.05）；Ⅲ级和Ⅳ级并发症比较，TURP组显著高于HoLEP组（P<0.05）；Ⅰ级和Ⅴ级3组间差异无统计学意义（P>0.05）。结论各项并发症和Clavien-Dindo分级结果比较表明PKRP和HoLEP并发症少，安全性高，值得临床推荐使用。Clavien-Dindo分级有利于手术并发症评价和比较的标准化，但还需要进一步完善和发展。
목적：비교경뇨도전렬선전절술（TURP）、쌍겁등리자절제술（PKRP）급화격광완제술（HoLEP）삼충술식병발증차이，초보탐토Clavien-Dindo분급대3충술식병발증표준화평개적응용개치。방법2010년1월지2013년12월재본원비뇨외과접수강경수술적전렬선증생환자625례안조술식분위3조：TURP（214례）、PKRP（207례）화HoLEP（204례），분별통계3조각항병발증차이병납입Clavien-Dindo분급진행비교。결과3조환자일반자료비교차이무통계학의의（P>0.05），TURP조각항적병발증발생솔총체상고우PKRP조화HoLEP조，기중전해질실평형、술중대량실혈、뇨로자격증상、뇨로도새、전렬선전절종합정、술후발기공능장애3조간차이유통계학의의（P<0.05）。안조Clavien-Dindo분급，Ⅱ급병발증비교，TURP조현저고우PKRP조화HoLEP조（P<0.05）；Ⅲ급화Ⅳ급병발증비교，TURP조현저고우HoLEP조（P<0.05）；Ⅰ급화Ⅴ급3조간차이무통계학의의（P>0.05）。결론각항병발증화Clavien-Dindo분급결과비교표명PKRP화HoLEP병발증소，안전성고，치득림상추천사용。Clavien-Dindo분급유리우수술병발증평개화비교적표준화，단환수요진일보완선화발전。
Objective To compare the incidences of complications associated with 3 different endoscopic procedures, namely transurethral resection of prostate (TURP), bipolar plasmakinetic resection of the prostate (PKRP), and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) and assess the clinical value of the Clavien-Dindo classification system for standardizing the evaluation of the complications. Methods Between January 2010 and December 2013, a total of 625 patients with BPH scheduled for endoscopic surgery underwent TURP (214 cases), PKRP (207 cases), or HoLEP (204 cases). The complications were recorded in each group and analyzed using the Clavien-Dindo classification system. Results There was no significant difference in the baseline data among the 3 groups (P>0.05). TURP was associated with a higher total incidence rate of complications than PKRP and HoLEP, and the incidences of electrolyte disturbance, massive intraoperative hemorrhage, urinary irritation symptom, urinary blockage, transurethral resection syndrome (TRUS), and erectile dysfunction (ED) differed significantly among the 3 groups (P<0.05). According to Clavien-Dindo classification, the incidence of grade II complications was significantly higher in TURP group than in PKRP and HoLEP groups (P<0.05), and that of grades III and IV complications was significantly higher in TURP group than in HoLEP group (P<0.05);no significant difference was found in grade I or V complications among the 3 groups (P>0.05). Conclusion According to the results of Clavien-Dindo classification analysis, PKRP and HoLEP are associated with fewer complications with a better safety profile in the treatment of BPH. The current Clavien-Dindo classification system can contribute to standardized evaluation of surgical complications but still needs further modifications for better performance.