保留前列腺尖部组织的经尿道等离子前列腺 剜除术整体剜除治疗中等体积前列腺增生 的临床效果观察

Clinical Observation of the Overall Enucleation Effect of Transurethral Plasma Enucleation of the Prostate with Preservation of the Prostatic Apex Tissue in the Treatment of Moderate-Volume Benign Prostatic Hyperplasia

摘要: 目的：探讨保留前列腺尖部组织的经尿道等离子前列腺整体剜除术，对于中等体积前列腺增生患者的临床应用效果。方法：本研究回顾性分析2023年6月至2024年5月在昆明医科大学第二附属医院接受手术治疗的60例良性前列腺增生患者。观察组采用保留前列腺尖部组织的经尿道等离子前列腺剜除术30例，对照组采用传统经尿道等离子前列腺剜除术30例。比较两组患者一般资料、围手术期指标、术后尿控及并发症有无差异。结果：观察组和对照组均顺利完成手术，观察组在术后血红蛋白下降量、留置导尿管及膀胱冲洗时间少于对照组，差异无统计学意义(P > 0.05)；观察组手术时间、术后住院时间少于对照组，差异有统计学意义(P < 0.05)。观察组和对照组在术前IPSS、QOL评分及Qmax、PVR比较中，差异无统计学意义(P > 0.05)；在术后IPSS、QOL评分比较中，观察组低于对照组，拔除尿管后的24 h内及术后1周，观察组的尿失禁发生率低于对照组，差异有统计学意义(P < 0.05)。术后Qmax水平高于术前，观察组高于对照组，术后PVR水平低于术前，观察组低于对照组，差异有统计学意义(P < 0.05)。两组术后随访3个月，并发症发生率比较，差异没有统计学意义(P > 0.05)。结论：保留前列腺尖部组织的经尿道等离子前列腺剜除术整体剜除治疗中等体积前列腺增生的手术方式可缩短手术时间、术后住院时间，有助于缩短术后恢复时间，术后患者排尿功能恢复较好，生活质量满意度较高，且能够减少患者术后短期尿失禁。

Abstract: Objective: To explore the clinical application effect of transurethral plasmakinetic enucleation of the prostate with preservation of the prostatic apex tissue in patients with moderate-sized benign prostatic hyperplasia. Methods: This study retrospectively analyzed 60 patients with benign prostatic hyperplasia who underwent surgical treatment at the Second Affiliated Hospital of Kunming Medical University from June 2023 to May 2024. The observation group comprised 30 cases treated with transurethral plasma enucleation of the prostate with preservation of the prostatic apical tissue, whereas the control group received conventional transurethral plasma enucleation of the prostate in 30 cases. The study compared demographic characteristics, perioperative indicators, postoperative urinary control, and complication rates between the two groups. Results: The surgical interventions were successfully performed in both study cohorts. When comparing postoperative outcomes, the experimental cohort demonstrated reduced hemoglobin decline, shorter catheter retention periods, and decreased bladder irrigation durations relative to the comparison group, though these variations did not reach statistical significance (P > 0.05). Notably, the experimental group exhibited substantially shorter operative durations and reduced hospitalization periods compared to the control group, with these differences proving statistically meaningful (P < 0.05). Initial assessments of IPSS, quality of life metrics, maximum urinary flow rates, and postvoid residual volumes revealed no significant intergroup disparities prior to surgery (P > 0.05). Following the procedure, the experimental group showed marked improvements in IPSS and quality of life scores compared to controls. Additionally, during the initial 24-hour period after catheter extraction and at the one-week postoperative evaluation, the experimental cohort displayed a significantly lower occurrence of urinary incontinence relative to the control group. The analysis revealed clinically meaningful variations (P < 0.05) between the measured parameters. When examining urinary flow rates, postoperative Qmax measurements demonstrated notable improvement from baseline levels, with the study group exhibiting superior outcomes relative to the comparison group. Regarding residual urine volumes, postoperative PVR measurements showed substantial reduction from preoperative values, with the experimental group displaying significantly better results than the reference group, all reaching statistical significance (P < 0.05). Throughout the 90-day monitoring period following surgery, Evaluation of adverse event frequencies between both cohorts did not yield statistically meaningful distinctions (P > 0.05). Conclusion: The transurethral plasma prostate enucleation surgery that retains the apex tissue of the prostate and is used for the overall enucleation treatment of medium-sized prostatic hyperplasia can shorten the operation time and postoperative hospital stay, help shorten the postoperative recovery time, result in better recovery of the patient’s urination function after surgery, higher satisfaction with quality of life, and reduce the incidence of short-term urinary incontinence.