【摘要】 目的 探讨经尿道等离子双极电切术（PKRP）治疗前列腺增生的安全性及临床疗效。 方法 2009年2-12月，采用PKRP治疗前列腺增生患者76例，记录手术时间、手术疗效及术后并发症。 结果 患者手术时间35～130 min，平均55 min。术中失血60～150 mL，均未输血。手术切除前列腺质量18～72 g。无直肠和膀胱穿孔，无电切综合征（TURS）及闭孔神经反射发生，无一例发生真性尿失禁，无死亡。术后随访2～6个月，IPSS评分平均为9分，最大尿流率平均为16.7 mL/s。 结论 PKRP是治疗前列腺增生的理想方法之一。【Abstract】 Objective To evaluate the efficacy of transurethral plasmakinetic resection of the prostate (PKRP) on benign prostatic hyperplasia. Methods A total of 76 patients with benign prostatic hyperplasia from February to December 2009 were treated with PKRP. The operative duration, therapeutic effect and postoperative complications were observed and recorded. Results The operative duration ranged from 35 to 130 minutes (average 55 minutes).The intraoperative blood loss was 60-150 mL, and no one needed transfusion.The prostate gland excised weight was 18-72 g. There were no intestinal and bladder perforation, no transurethral resection syndrome (TURS) or obturator nerve reflex occurs, and no urinary incontinence or death.IPSS score was nine and the maximal average uroflow was 16.7 mL/s during the 2-6 month follow-up. Conclusion PKRP is one of the ideal methods treating benign prostatic hyperplasia, especially for high-risk patients with benign prostatic hyperplasia.
目的:探讨基层医院前列腺增生并膀胱结石的微创治疗方法。方法:联合经尿道等离子双极电切与耻骨上小切口治41例前列腺增生症并膀胱结石。结果:手术时间40~110min, 平均55min,术后3d拔造瘘管, 第5~6天拔除尿管,排尿通畅, 无电切综合征(TURS)、大出血等并发症,住院时间7±1.5天。数字疼痛评分0~6,平均3.5。结论：等离子体双极电切结合耻骨上小切口是治疗前列腺增生并膀胱结石的一种快速、安全有效、微创的手术方法,值得在基层医院推广。
ObjectivesTo systematically evaluate the efficacy and safety of the transurethral bipolar plasmakinetic prostatectomy (TUPKP) versus holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of TUPKP and HoLEP for treatment of BPH from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, the meta-analyses were performed by using RevMan 5.3 software.ResultsA total of 9 RCTs involving 784 patients were included. The results of meta-analyses showed that, in efficacy outcomes, TUPKP was superior to HoLEP in Qmax at 48 months, and was inferior to HoLEP in PVR at 3 months, Qmax in 60 and 72 months, and IIEF-5 at 48 and 72 months. No significant association was found between two groups in Qmax from 1 to 36 months, IPSS from 1 to 72 months, prostate volume, PVR from 6 months, IIEF-5 from 1 to 24 months, QoL at 1 to 36 months, and resected prostate weight. As for safety, TUPKP was superior to HoLEP in operation time, while inferior to HoLEP in blood loss during procedure, hospital stay, catheterization period, bladder irrigation period, irrigation fluid, massive hemorrhage and hematuresis. No significant association was observed between two groups in serum sodium decrease, hemoglobin decrease, PSA, postoperative urine retention, blood transfusion, cystospasm, temporary incontinence, urinary tract infection, TURS, epididymitis, temporary difficulty in urination, urinary tract irritation syndrome, reoperation, retrograde ejaculation, urinary incontinence, ED and urethrostenosis.ConclusionsCurrent evidence shows that the efficacy and safety of TUPKP and HoLEP for treatment of BPH are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.