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目的:总结连续实施经尿道前列腺双极剜除术治疗症状性BPH的临床安全性、疗效及学习曲线。方法:回顾性分析自2010年1月～2011年1月行经尿道前列腺双极剜除术治疗100例症状性BPH患者围手术期及随访资料,以中转为普通双极TURP比例剜除、剜除效率等指标评估学习曲线。结果:共83例患者完成经尿道前列腺双极剜除术,无中转开放手术。术前前列腺体积(74.8±27.05)ml,血红蛋白(131.72±8.01)g/L,IP-SS评分(25.37±3.55)分,QOL(4.33±0.91)分,术前最大尿流率(Qmax)(6.54±2.95)ml/s,手术时间(117.5±37.22)min,术后3天血红蛋白(125.03±6.64)g/ml,术后留置尿管时间(3.3±1.9)d,术前与术后血清钠无明显变化。6个月后剩余前列腺体积(35.29±17.57)ml,Qmax(21.34±4.09)ml/s,IPSS评分(9.66±2.64)分,QOL(2.31±0.92)分。术后1个月内压力性尿失禁8例,均于术后3个月恢复;尿道外口狭窄发生3例,无后尿道及球部尿道狭窄发生,无膀胱颈挛缩发生。学习曲线中,Qmax、IPSS和QOL评分随手术例次增加无明显差异,但中转为普通双极TURP在经历30例后明显减少,剜除效率随手术例数累积明显提高,约50例次后处于平台期。结论:经尿道前列腺双极剜除术可安全用于症状性BPH的治疗,具有良好的临床疗效。其学习曲线在经历30例后可安全实施,50例后技术逐渐成熟并进入平台期。
OBJECTIVE: To summarize the clinical safety, curative effect and learning curve of continuous transurethral transurethral prostatectomy for the treatment of symptomatic BPH. Methods: The data of perioperative period and follow-up of 100 patients with BPH who underwent transurethral resection of the prostate (BPH) from January 2010 to January 2011 were retrospectively analyzed. Efficiency and other indicators to assess the learning curve. Results: A total of 83 patients underwent transurethral resection of bipolar prostatectomy without open surgery. Preoperative prostate volume (74.8 ± 27.05) ml, hemoglobin (131.72 ± 8.01) g / L, IP-SS score of 25.37 ± 3.55, QOL of 4.33 ± 0.91, preoperative maximum flow rate (Qmax) 6.54 ± 2.95) ml / s, operation time (117.5 ± 37.22) min, hemoglobin (125.03 ± 6.64) g / ml after 3 days and postoperative indwelling catheter time (3.3 ± 1.9) d, preoperative and postoperative serum No significant change in sodium. The remaining prostate volume (35.29 ± 17.57) ml, Qmax (21.34 ± 4.09) ml / s, IPSS score (9.66 ± 2.64) and QOL (2.31 ± 0.92) points after 6 months. Eight cases of stress urinary incontinence within 1 month after operation were recovered 3 months after operation. There were 3 cases of urethral stenosis and no urethral stricture of urethra and bulb occurred. No bladder neck contracture occurred. Learning curve, Qmax, IPSS and QOL scores increased with the surgery there was no significant difference, but the transfer to ordinary bipolar TURP experienced 30 cases significantly reduced, removal efficiency with the cumulative number of cases increased significantly, about 50 cases after In the platform period. Conclusion: Transurethral biopolar prosthesis can be safely used in the treatment of symptomatic BPH, and has good clinical efficacy. The learning curve can be implemented safely after 30 cases, after 50 cases the technology has gradually matured and entered the platform period.