Michielsen Dirk P J, Debacker Tibaut, De Boe Veerle, Van Lersberghe Caroline, Kaufman Leonard, Braeckman Johan G, Amy Jean-Jacques, Keuppens Frans I
Department of Urology, Vrije Universiteit Brussel, Brussels, Belgium.
J Urol. 2007 Nov;178(5):2035-9; discussion 2039. doi: 10.1016/j.juro.2007.07.038. Epub 2007 Sep 17.
The transurethral resection in saline system uses bipolar energy for transurethral prostate resection, thus, avoiding the need for glycine irrigation and its associated complications. We compared the clinical efficacy and safety of bipolar transurethral resection in saline and of monopolar transurethral prostate resection for symptomatic benign prostate hyperplasia.
From January 2005 to June 2006, 238 consecutive patients with symptomatic benign prostate hyperplasia were randomized into a prospective, controlled trial comparing the 2 treatment modalities. Patient demographics, operative time, hospital stay and complications were noted. Serum hemoglobin and electrolytes were determined in all patients immediately before and after the endoscopic procedure.
During 18 months 120 patients were randomized to the conventional transurethral prostate resection group and 118 were randomized to the transurethral resection in saline group. Patient profiles, weight of resected prostatic tissue and duration of hospitalization were similar in the 2 groups. The decrease in serum sodium and serum chloride was statistically significantly greater in the transurethral prostate resection group than in the transurethral resection in saline group (each p = 0.05). The transurethral resection in saline procedure required significantly more time (mean 56 vs 44 minutes, p <0.01). There was 1 case (0.8%) of transurethral resection syndrome in the transurethral prostate resection group but none in the transurethral resection in saline group. Postoperative bleeding did not significantly differ between the 2 groups. Clot retention was observed in 6 (5%) and 4 patients (3%) in the transurethral prostate resection and transurethral resection in saline group, respectively. Two repeat interventions were required in the transurethral prostate resection group.
The bipolar transurethral resection in saline system is as efficacious as monopolar transurethral prostate resection but it is safer than the latter because of the lesser decrease in postoperative hypernatremia and the smaller risk of transurethral resection syndrome. However, probably due to technical reasons, transurethral resection in saline operative time is significantly longer.
生理盐水系统经尿道切除术使用双极能量进行经尿道前列腺切除术，从而避免了使用甘氨酸冲洗及其相关并发症。我们比较了生理盐水双极经尿道切除术与单极经尿道前列腺切除术治疗有症状良性前列腺增生的临床疗效和安全性。
2005年1月至2006年6月，238例有症状良性前列腺增生患者连续纳入一项前瞻性对照试验，比较两种治疗方式。记录患者人口统计学资料、手术时间、住院时间和并发症。在内镜手术前后即刻测定所有患者的血清血红蛋白和电解质。
在18个月期间，120例患者被随机分配至传统经尿道前列腺切除术组，118例被随机分配至生理盐水经尿道切除术组。两组患者的资料、切除前列腺组织重量和住院时间相似。经尿道前列腺切除术组血清钠和血清氯的降低在统计学上显著大于生理盐水经尿道切除术组（均p = 0.05）。生理盐水经尿道切除手术所需时间显著更长（平均56分钟对44分钟，p <0.01）。经尿道前列腺切除术组有1例（0.8%）发生经尿道切除综合征，而生理盐水经尿道切除术组无此情况。两组术后出血无显著差异。经尿道前列腺切除术组和生理盐水经尿道切除术组分别有6例（5%）和4例（3%）患者出现血块残留。经尿道前列腺切除术组需要进行两次重复干预。
生理盐水系统双极经尿道切除术与单极经尿道前列腺切除术疗效相当，但由于术后高钠血症降低较少且经尿道切除综合征风险较小，故比后者更安全。然而，可能由于技术原因，生理盐水经尿道切除手术时间显著更长。
