经尿道前列腺中叶等离子电切术联合术后非那雄胺治疗高龄高危良性前列腺增生患者的短期临床效果

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摘要

目的探讨经尿道前列腺中叶等离子电切术联合术后非那雄胺治疗高龄高危良性前列腺增生（BPH）患者的短期临床效果。方法选取2012年1月～2019年1月在我院治疗的78例以中叶增生为主的高龄高危BPH患者作为研究对象，按照随机数字表法将其分为A组（39例）与B组（39例）。A组患者采用经尿道前列腺电切术（TURP）的治疗方法，B组患者采用经尿道前列腺中叶等离子电切术联合术后非那雄胺的治疗方法。比较两组患者的手术时间、术中出血量、术后住院时间、术后尿管拔除时间、术后膀胱持续冲洗时间、手术并发症发生情况及手术前后临床相关指标[国际前列腺症状评分（IPSS）、生活质量指数（QOL）评分、最大尿流率（Qmax）、残余尿量（RUV）、前列腺体积（PV）]。结果 B组患者的手术时间、术后住院时间、术后尿管拔除时间及术后膀胱持续冲洗时间均短于A组，差异有统计学意义（P<0.05）；B组患者的术中出血量少于A组，差异有统计学意义（P<0.05）。B组患者的术中及术后并发症总发生率均低于A组，差异有统计学意义（P<0.05）。两组患者术前的IPSS评分、QOL评分、Qmax、RUV、PV比较，差异均无统计学意义（P>0.05）；两组患者术后3、6个月的IPSS评分、QOL评分、RUV、PV 低于术前，Qmax 高于术前，差异均有统计学意义（P<0.05）；B组患者术后3、6个月的IPSS、QOL评分均低于A组，Qmax高于A组，差异有统计学意义（P<0.05）；两组患者术后3个月的RUV、PV比较，差异无统计学意义（P>0.05）；B组患者术后6个月的RUV、PV均低于A组，差异有统计学意义（P<0.05）。结论经尿道前列腺中叶等离子电切术联合术后非那雄胺治疗高龄高危BPH的短期效果优于传统TURP，能降低手术风险，提高患者的生活质量，改善预后，可为临床上手术治疗以前列腺中叶增生为主的高龄高危BPH患者提供一种新的治疗选择策略。

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关键词 ：前列腺中叶增生, 经尿道前列腺等离子电切术, 经尿道前列腺电切术, 非那雄胺, 高龄高危患者

Abstract：

Objective To investigate the short-term clinical effect of transurethral plasmakinetic resection of mid-lobal of prostate combined with postoperative Finasteride in the treatment of elderly patients with high-risk benign prostatic hyperplasia (BPH).Methods From January 2012 to January 2019, 78 dominated by mid-lobal hyperplasia of elderly patients with high-risk BPH were selected as the study subjects in our hospital.They were divided into group A (39 cases) and group B (39cases) by the random number table method.The methods used in group A and group B were respectively for transurethral resection of the prostate (TURP) and transurethral plasmakinetic resection of mid-lobal of prostate combined with postoperative Finasteride.The operation time, intraoperative blood loss, postoperative hospitalization time, postoperative urinary catheter removal time, postoperative continuous bladder flushing time, incidence of surgical complications and clinical relevant indicators(international prostate symptom score [IPSS], quality of life index [QOL]score, maximum urine flow rate [Qmax],residual urine volume [RUV]and prostate volume [PV])before and after surgery were compared in the two groups.Results The operation time, postoperative hospitalization time, postoperative urinary catheter removal time and postoperative continuous bladder flushing time of patients in the group B were shorter than those in the group A, with statistically significant differences (P<0.05).The intraoperative blood loss of patients in the group B was less than that in the group A, and the difference was statistically significant (P<0.05).The total incidence rates of intraoperative and postoperative complications of patients in the group B were lower than those in the group A, with statistically significant differences (P<0.05).There were no statistically significant differences in IPSS score, QOL score, Qmax, RUV, PV before surgery between the two groups of patients (P>0.05).The IPSS score, QOL score, RUV and PV at 3 and 6 months after surgery in the two groups were lower than those before surgery, and Qmax was higher than that before surgery, with statistically significant differences (P<0.05).The IPSS and QOL scores at 3 and 6 months after surgery in the group B were lower than those in the group A, and Qmax was higher than that in the group, with statistically significant differences (P<0.05).There were no statistically significant differences in RUV and PV between the two groups of patients at 3 months after surgery (P>0.05).The RUV and PV at 6 months after surgery in the group B were lower than those in the group A, with statistically significant differences (P<0.05).Conclusion Short-term effect of transurethral plasmakinetic resection of mid-lobal of prostate combined with postoperative Finasteride to treat elderly patients with high-risk BPH is superior to that of traditional TURP,which can reduce the risk of surgery, improve the quality of life of patients, make better the prognosis of patients.It can provide a new treatment selection strategy for the clinical treatment of elderly patients with high-risk BPH mainly with mid-lobal of prostate hyperplasia.

Key words： Mid-lobal of prostate hyperplasia Transurethral plasmakinetic resection of prostate Transurethral resection of the prostate Finasteride Elderly and high-risk patients

通讯作者: 黄长青（1965-），男，广东湛江人，本科，毕业于广东医学院泌尿外科专业，主任医师，科室主任，研究方向及专业擅长：泌尿系肿瘤、结石及男性不育

作者简介: 蔡智仁（1988-），男，广东湛江人，本科，毕业于广东医学院泌尿外科专业，主治医师，研究方向及专业擅长：泌尿系肿瘤、结石及男性不育

引用本文:

蔡智仁；黄长青；朱陈辉；高绍青；杨水华；吴鸿. 经尿道前列腺中叶等离子电切术联合术后非那雄胺治疗高龄高危良性前列腺增生患者的短期临床效果[J]. 中国当代医药, 2020, 27(20): 13-18.
CAI Zhi-ren HUANG Chang-qing▲ ZHU Chen-hui GAO Shao-qing YANG Shui-hua WU Hong. Short-term clinical effect of transurethral plasmakinetic resection of midlobal of prostate combined with postoperative Finasteride in the treatment of elderly patients with high-risk benign prostatic hyperplasia. 中国当代医药, 2020, 27(20): 13-18.

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