耻骨后保留尿道与耻骨上经膀胱前列腺切除术疗效比较

A comparison of suprapubic transvesical and reserving the prostatic urethra prostatectomy for the treatment of benign prostatic hyperplasia

  • 摘要: 目的: 比较耻骨后保留尿道与耻骨上经膀胱前列腺切除术的近期疗效及术后并发症,探讨治疗良性前列腺增生症(BPH)的理想开放手术方法。方法: 将310例良性前列腺增生症(BPH)患者分成两组,采用耻骨后保留尿道前列腺切除术150例,耻骨上经膀胱前列腺切除术160例。比较两组平均手术时间、术中出血量、术后血红蛋白、留置尿管时间、最大尿流率及术后并发症等指标的差异。结果: 保留尿道组术中平均出血量(184.2±34.5)ml与对照组(356.6±38.4)ml相比显著性减少(P<0.05)。保留尿道组术后膀胱冲洗时间(2.7±1.2)d、留置尿管时间(5.6±2.7)d、平均住院日(20±0.5)d及术后发生膀胱痉挛等并发症与对照组比较有显著性差异(P<0.05)。而平均手术时间、术后尿流率指标变化、症状及生活质量改善两组差异无显著性意义(P>0.05)。结论: 耻骨后保留尿道前列腺切除术手术创伤小,术中及术后出血少,避免尿道损伤进而减少术后膀胱痉挛疼痛等并发症,术后恢复快,不影响性功能,是治疗前列腺增生症的理想开放术式。

     

    Abstract: Objective: To review and compare the outcome of patients with benign prostatic hyperplasia (BPH) undergoing suprapubic transvesical prostatectomy or Madigan prostatectomy.Methods: Suprapubic transvesical prostatectomy was performed in 150 patients of BPH and Madigan prostatectomy carried out for 160 patients. The following variables were assessed: operation time, estimated blood loss (EBL) and serum hemoglobin, length of stay, short-term complication rates. Results: There were no significant differences in either the preoperative and postoperative IPSS or urodynamic parameters in both groups. The chief advantages of the Madigan prostatectomy were less trauma to the urethra, which resulted in significantly little blood loss(184.2 ±34.5ml versus 356.6±38.4ml), shorter catheterzation duration(5.6±2.7d versus 12.2±5.1d)and length of stay(20±0.5d versus 29±0.7d), few complications, rapid recovery and preservation of antegrade ejaculation. All these differences were statistically significant compared with suprapubic transvesical methods(P<0.05). Conclusion: The Madigan prostatectomy is believed to be the effective and ideal open prostatectomy, and provided good surgical results in our experience.

     

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