Use of Superpulse Plasmakinetic Body in Transurethral Intracavitary Retrograde Enucleation and Vaporization Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia_West China Medical Journal

Authors：

GU Xinwei ¹ , ZHENG Zhongjin ² , XU Yahong ¹ , ZHAO Qihua ¹

1. Department of Urology, 2. Department of General Surgery, 452 Hospital of PLA, Chengdu, Sichuan 610021, P. R. China;

Corresponding author：

Keywords：

前列腺增生; 超脉冲等离子; 前列腺; 经尿道前列腺剜除术

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【摘要】　目的　探讨经尿道超脉冲等离子体腔内逆行剜除汽化切除术治疗良性前列腺增生的有效性和安全性。　方法　 2008年4月－2009年4月，应用Gyrus超脉冲等离子体行经尿道前列腺腔内逆行剜除汽化切除术124例，前列腺重量为（62.3±21.7） g。术中首先用电切镜鞘、电切环钝锐性相结合将前列腺增生腺体沿外科包膜逆行剥离、剜除，同时断血供，然后推至膀胱颈处后切除。统计手术时间、术中出血量及收集到的前列腺组织质量，术后留置尿管时间、住院时间、手术后前列腺特异性抗原（prostatic specific antigen，PSA）、残余尿量（post voiding residual volume，PVR）、最大尿流率（Qmax）、国际前列腺症状评分（international prostatic symptom scores，IPSS）及生活质量评分（quality of life，QOL）等指标的变化。　结果　 124例手术顺利完成。手术时间（48.1±19.4） min，腺体组织质量（57.6±19.6） g，平均失血量（86.2±20.7） mL，仅1例需要输血，出血量和手术时间随前列腺体积和重量的增加而相应增加和延长。术后留置尿管时间（3.1±1.6） d，住院时间（5.8±1.4） d。随访6～18个月，所有患者术后1、6个月Qmax、PVR、IPSS、QOL均较术前得到改善，与术前比较差异均有统计学意义（P lt;0.05）。术后6个月血清PSA降至（0.90±0.26） ng/mL，与术前比较差异有统计学意义（P lt;0.05）。继发尿道外口狭窄3例，经尿道扩张治疗后恢复排尿通畅；继发尿失禁2例，经保守治疗分别于术后1～6个月恢复；无永久性尿失禁、再次手术止血患者，无手术死亡者，未发生经尿道前列腺电切综合征。　结论　经尿道超脉冲等离子体腔内逆行剜除汽化切除术治疗良性前列腺增生安全有效，值得临床推广使用。
【Abstract】　Objective　 To evaluate the safety and clinical efficacy of superpulse plasmakinetic body in transurethral intracavitary retrograde enucleation and vaporization resection of the prostate (TUEVRP) for the treatment of benign prostatic hyperplasia (BPH).　Methods　 Between April 2008 and April 2009, Gyrus TUEVRP was performed on 124 patients with obstructive BPH whose mean prostatic weight was (62.3±21.7) g. The hyperplasia prostate glands were retrogradely dissected and enucleated along surgical capsule to the bladder neck by sharp and blunt dissection combination of the resectoscope tip or loop. Simultaneously, the blood supply of the gland was clamped. The changes of such indexes as operating time, perioperative blood loss, collected prostatic specimen weight, postoperative catheterization time, hospitalization time, prostatic specific antigen (PSA), post voiding residual volume (PVR), maximum urinary flow rate (Qmax), international prostatic symptom score (IPSS), and quality of life (QOL) were assessed.　Results　 All surgeries were successfully carried out with an average operation time of (48.1±19.4) minutes ranged from 25 to 175 minutes. The mean collected prostatic specimen weight was (57.6±19.6) g ranged from 20.2 to 125.7 g. The blood loss was ranged from 45 to 350 ml, averaging at (86.2±20.7) mL during the operation. Blood transfusion was needed in only one case. Blood loss and operation time were increased and prolonged in accordance with the increase of prostatic volume and weight. The postoperative catheterization time was ranged from 2 to 5 days, averaging at 3.1±1.6. The mean hospitalization time was (5.8±1.4) days ranged from 5 to 8 days. All patients were followed up for 6 to 18 months. Qmax, PVR, IPSS and QOL-score six months after operation were significantly improved compared with those before operation (P lt;0.05). There were three cases of external urethral stricture, and they were treated with urethral dilatation successfully. Two cases of urinary incontinence recovered 1 and 6 months later, respectively, by traditional treatment. There were no cases of permanent urinary incontinence, reoperation for hemostasis, operative death, or transurethral resection syndrome.　Conclusion　 TUEVRP is safe and clinically efficacious in the treatment of BPH, and is worthy of clinical promotion.

Citation： GU Xinwei,ZHENG Zhongjin,XU Yahong,ZHAO Qihua. Use of Superpulse Plasmakinetic Body in Transurethral Intracavitary Retrograde Enucleation and Vaporization Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia. West China Medical Journal, 2011, 26(7): 1050-1053. doi: Copy

1.	Kaplan SA.Transurethral resection of the prostate-is our gold standard still a precious commodity? [J]. J Urol, 2008, 180(1): 15-16.
2.	Mamoulakis C, Trompetter M, de la Rosette J. Bipolar transurethral resection of the prostate: the “golden standard”reclaims its leading position[J]. Curr Opin Urol, 2009, 19(1): 26-32.
3.	Mundy AR.Management of urethral strictures[J]. Postgrad Med J, 2006, 82(970): 489-493.
4.	郑少波, 刘春晓, 徐亚文. 前列腺腔内逆行剥离法在经尿道前列腺汽化切除术中的应用[J]. 第一军医大学学报, 2005, 25(6): 734-738.
5.	张宗平, 王安果, 刘照功, 等. 经尿道前列腺电切术10年回顾[J]. 华西医学, 2001, 17(3): 386-387.
6.	Reich O, Gratzke C, Bachmann A, et al. Morbidity,mortality and early outcome of transurethral resection of the prostate:a prospective multicenter evaluation of 10,654 patients[J]. J Urol, 2008, 180(1): 246-249.
7.	Iori F, Franco G, Leonarde C, et al. Bipolar transurethral resection of the prostate:clinical and urodynamic evaluation[J]. Urology, 2008, 71(2): 252-255.
8.	蒋诗坤, 刘洋. 经尿道等离子电切术治疗前列腺增生症[J]. 华西医学, 2006, 21(1): 22.
9.	Michielsen DP, Debacker T, De Boe V, et al. Bipolar transurethral resection in saline-an alternative surgical treatment for bladder outlet obstruction? [J]. J Urol, 2007, 178(5): 2035-2039.
10.	Thiel DD, Petrou SP. Electroresection and open surgery[J]. Urol Clin North Am, 2009, 36(4): 461-70.
11.	郑少波, 刘春晓, 徐亚文, 等. 腔内剜除法在经尿道前列腺汽化电切术中的应用[J]. 中华泌尿外科杂志, 2005, 26(8): 558-561.
12.	朱卫国, 何秉勋, 欧阳波. 经尿道单极电切剜除法治疗前列腺增生[J]. 华西医学, 2009, 24(1): 101-102.

1. 　Kaplan SA.Transurethral resection of the prostate-is our gold standard still a precious commodity? [J]. J Urol, 2008, 180(1): 15-16.
2. 　Mamoulakis C, Trompetter M, de la Rosette J. Bipolar transurethral resection of the prostate: the “golden standard”reclaims its leading position[J]. Curr Opin Urol, 2009, 19(1): 26-32.
3. 　Mundy AR.Management of urethral strictures[J]. Postgrad Med J, 2006, 82(970): 489-493.
4. 　郑少波, 刘春晓, 徐亚文. 前列腺腔内逆行剥离法在经尿道前列腺汽化切除术中的应用[J]. 第一军医大学学报, 2005, 25(6): 734-738.
5. 　张宗平, 王安果, 刘照功, 等. 经尿道前列腺电切术10年回顾[J]. 华西医学, 2001, 17(3): 386-387.
6. 　Reich O, Gratzke C, Bachmann A, et al. Morbidity,mortality and early outcome of transurethral resection of the prostate:a prospective multicenter evaluation of 10,654 patients[J]. J Urol, 2008, 180(1): 246-249.
7. 　Iori F, Franco G, Leonarde C, et al. Bipolar transurethral resection of the prostate:clinical and urodynamic evaluation[J]. Urology, 2008, 71(2): 252-255.
8. 　蒋诗坤, 刘洋. 经尿道等离子电切术治疗前列腺增生症[J]. 华西医学, 2006, 21(1): 22.
9. 　Michielsen DP, Debacker T, De Boe V, et al. Bipolar transurethral resection in saline-an alternative surgical treatment for bladder outlet obstruction? [J]. J Urol, 2007, 178(5): 2035-2039.
10. 　Thiel DD, Petrou SP. Electroresection and open surgery[J]. Urol Clin North Am, 2009, 36(4): 461-70.
11. 　郑少波, 刘春晓, 徐亚文, 等. 腔内剜除法在经尿道前列腺汽化电切术中的应用[J]. 中华泌尿外科杂志, 2005, 26(8): 558-561.
12. 　朱卫国, 何秉勋, 欧阳波. 经尿道单极电切剜除法治疗前列腺增生[J]. 华西医学, 2009, 24(1): 101-102.

West China Medical Journal

Use of Superpulse Plasmakinetic Body in Transurethral Intracavitary Retrograde Enucleation and Vaporization Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia

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