Hon N H Y, Brathwaite D, Hussain Z, Ghiblawi S, Brace H, Hayne D, Coppinger S W V
Shrewsbury and Telford Hospital National Health Service Trust, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire, United Kingdom.
J Urol. 2006 Jul;176(1):205-9. doi: 10.1016/S0022-5347(06)00492-7.
We compared standard transurethral prostate resection with bipolar PlasmaKinetic prostate vaporization for bladder outflow obstruction using a Gyrus PlasmaKinetic Plasma V bar.
A total of 160 men were enrolled in a prospective, randomized trial. Those at higher risk for cancer were excluded by prostate specific antigen and digital rectal examination with or without transrectal ultrasound biopsy. A total of 81 men underwent prostate vaporization and 79 underwent transurethral prostate resection. Preoperative International Prostate Symptom Score and quality of life score, uroflowmetry, post-void residual urine and transrectal ultrasound prostate volume were recorded. Preoperative and postoperative serum hemoglobin, hematocrit and sodium were measured. Perioperative fluid absorption was calculated using weighing on table and blood loss using the Hemocue system. Longer followup of International Prostate Symptom Score and quality of life score, uroflowmetry and post-void residual urine was available in 149 men, including 76 who underwent prostate vaporization and 73 who underwent transurethral prostate resection. Data were analyzed using the 1 or 2-sample t and chi-square tests.
The 2 groups were comparable in all preoperative parameters. Perioperative fluid absorption, intraoperative blood loss, preoperative and postoperative serum hematocrit, and sodium changes were not statistically different. Mean resection time was 4 minutes shorter for transurethral prostate resection (28.5 vs 32.6 minutes, p = 0.08). Patients with transurethral prostate resection showed a greater hemoglobin decrease (1.39 vs 0.8 gm/dl, p = 0.002) and required more irrigation postoperatively (28.3 vs 20.4 l, p = 0.001). Four patients with transurethral prostate resection required transfusion compared with none who underwent prostate vaporization. After transurethral prostate resection hospital stay was longer (3.36 vs 3.02 days, p = 0.03). Cancer was detected in 8 patients with transurethral prostate resection (10%), of whom 7 are under prostate specific antigen surveillance and 1 received radical radiotherapy. Mean long-term followup was 258 days (range 82 to 884). Prostate vaporization and transurethral prostate resection were equally effective at followup, as evidenced by changes in maximum urine flow, International Prostate Symptom Score, quality of life score and post-void residual urine.
The 2 operations are highly effective in experienced hands. PlasmaKinetic prostate vaporization resulted in less postoperative bleeding and a slightly shorter hospital stay. The lack of a histological specimen with this version of PlasmaKinetic prostate vaporization may mean that clinically significant cancers are missed.
我们使用Gyrus等离子双极汽化系统比较了标准经尿道前列腺切除术与双极等离子前列腺汽化术治疗膀胱出口梗阻的效果。
共有160名男性参与了一项前瞻性随机试验。通过前列腺特异性抗原检测、直肠指检以及必要时的经直肠超声引导下活检，排除了癌症高危患者。共有81名男性接受了前列腺汽化术，79名接受了经尿道前列腺切除术。记录术前国际前列腺症状评分、生活质量评分、尿流率、排尿后残余尿量以及经直肠超声测定的前列腺体积。测量术前和术后的血清血红蛋白、血细胞比容及钠水平。通过手术台上称重计算围手术期液体吸收量，使用Hemocue系统测定失血量。149名男性患者（包括76名接受前列腺汽化术和73名接受经尿道前列腺切除术的患者）进行了更长时间的国际前列腺症状评分、生活质量评分、尿流率及排尿后残余尿量随访。使用单样本或两样本t检验及卡方检验对数据进行分析。
两组患者所有术前参数均具有可比性。围手术期液体吸收量、术中失血量、术前及术后血清血细胞比容及钠水平变化差异无统计学意义。经尿道前列腺切除术的平均切除时间短4分钟（28.5分钟对32.6分钟，p = 0.08）。经尿道前列腺切除术患者的血红蛋白下降幅度更大（1.39 g/dl对0.8 g/dl，p = 0.002），术后需要更多冲洗量（28.3升对20.4升，p = 0.001）。4名经尿道前列腺切除术患者需要输血，而接受前列腺汽化术的患者均无需输血。经尿道前列腺切除术后住院时间更长（3.36天对3.02天，p = 0.03）。经尿道前列腺切除术患者中有8例（10%）检测出癌症，其中7例接受前列腺特异性抗原监测，1例接受根治性放疗。平均长期随访时间为258天（范围82至884天）。最大尿流率、国际前列腺症状评分、生活质量评分及排尿后残余尿量的变化表明，前列腺汽化术和经尿道前列腺切除术在随访中疗效相当。
在经验丰富的医生手中，这两种手术都非常有效。等离子前列腺汽化术术后出血更少，住院时间略短。这种版本的等离子前列腺汽化术缺乏组织学标本，可能意味着会漏诊具有临床意义的癌症。
