目的 评价经尿道等离子舣极电切术(TUPKP)治疗高危前列腺增生(BPH)的疗效和安全性.方法 应用TUPKP治疗高危BPH 230例,其中132例剩余尿40～420 ml,长期服药无效,98例反复尿潴留.对体能>4 MET的173例采用标准经尿道前列腺电切术(TURP)治疗,<4 MET的57例采用微创TURP治疗,其中12例合并膀胱结石者先用钬激光碎石.对两组手术前后国际前列腺症状评分(IPSS)、最大尿流率(Qmax)和剩余尿等临床资料进行分析.结果 两组均无经尿道电切综合征发生.术后3～12个月随访,标准TURP组和微创TURP组IPSS由术前(21.9 ±5.7)分和(23.7±5.0)分降到(4.4±2.3)分和(5.5±2.4)分,剩余尿由(61.8±18.4)ml和(103.9±77.3)ml降到(13.0±6.2)ml和(15.8±6.1)ml,Qmax由术前(5.7±3.0)ml/s和(4.8±2.8)ml/s升到(20.9±6.3)ml/s和(16.8±3.9)ml/s,两组改善情况差异有统计学意义(P<0.01).但标准TURP组术后IPSS、Qmax和剩余尿的改善程度优于微创TuRP组(P<0.05).结论 应用TUPKP治疗高危BPH患者时,根据不同体能分别采用标准TURP和微创TURP治疗是安全有效的,当体能>4 MET时,最好选用标准TURP.%Objective To evaluate therapeutic effect and reliability of bipolar transurethral plasmakinetic prostatectomy (TUPKP) for high risk level binign prostatic hyperplasia (BPH). Methods A total of 230 cases of high risk of BPH were treated with TUPKP. Among them, 132 cases with the residual urine of 40 to 420 ml had accepted long term hut inefficient medical therapy, 98 cases were suffered with repeating acute urinary retention. One hundred and seventy-three cases with the functional capacity > 4 MET were performed the standard transurethral resection of the prostate (TURP), the other 57 cases with the functional capacity <4 MET were accepted the minimally invasive TURP. Among them 12 cases complicated with bladder stones accepted Ho: YAG lithotripsy priory. The international prostate symptom score (IPSS), The maximal urinary flow rate (Qmax) and residual urine of the 2 groups before and after operation were analyzed. Results There was no trensurethral resection syndrome occurred in both groups. After 3 to 12 months of follow-up postoperatively, the IPSS of the two groups were reduced from (21.9±5.7) and (23.7 ±5.0) to (4.4±2.3) and (5.5±2.4), residual urine were reduced from (61.8±18. 4) ml and ( 103.9 ±77.3) ml to ( 13.0±6.2) ml and ( 15.8±6.1 ) ml, respectively. The Qmax was increased from (5.7 ± 3.0) ml/s and (4. 8±2. 8) ml/s to (20.9±6.3) ml/s and (16.8±3.9) ml/s, there existed significant differences (P<0. 01 ). However the IPSS, Qmax and residual urine of the standard group had progressed more obviously than the minimally invasive TURP group ( P <0.05 ). Conclusions h is safe and effective to use TUPKP for treating high risk patients of BPH with classic TURP and minimally invasive TURP according to different functional capacity. When the functional capacity is more than 4 MET, the standard procedures is prefered.
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