【摘要】：目的：探討膀胱腫瘤合并良性前列腺增生患者同期行經尿道膀胱腫瘤電切術并良性前列腺增生電切術的可行性及療效，為臨床治療膀胱腫瘤合并良性前列腺增生提供一定的指導。 方法：回顧性分析我院自2009-03-01至2013-03-01收治的膀胱腫瘤合并良性前列腺增生患者共121例，其中同期行經尿道膀胱腫瘤電切術并良性前列腺增生電切術62例（A組），單純行經尿道膀胱腫瘤電切術59例（B組），通過對兩組術前、術后的臨床指標，術后的臨床療效、并發(fā)癥及腫瘤復發(fā)情況進行比較，以探討同期行經尿道電切手術治療膀胱腫瘤合并良性前列腺增生的可行性及治療效果。 結果：兩組患者均順利完成手術。A組術后隨訪9-36個月，平均22.50個月；B組術后隨訪7-36個月，平均22.75個月。 1同期行經尿道電切手術與單純行膀胱腫瘤電切術比較，可明顯改善患者排尿癥狀。術后隨訪6個月，A組患者平均I-PSS評分、QOL評分與術前比較，均具有顯著性差異（P0.01）；B組患者平均I-PSS評分、QOL評分與術前比較，均無顯著性差異（P0.05）。經組間比較，兩組術前I-PSS評分、QOL評分均無顯著性差異（P0.05）；術后A組患者排尿癥狀的改善明顯優(yōu)于B組患者，兩組I-PSS評分、QOL評分的比較均具有顯著性差異（P0.01）。B組患者中有6例于隨訪期內因良性前列腺增生行經尿道前列腺電切術，術后尿頻、尿急、排尿困難等癥狀較術前均明顯改善。 2兩組患者均成功完成手術。通過對兩組手術時間、出血量、膀胱沖洗時間、尿管保留時間的比較，A組患者較B組患者的手術時間明顯延長，術中出血量明顯增加，同時術后膀胱沖洗時間及尿管保留時間亦明顯延長，均具有顯著性差異（P0.01）；但兩組住院時間比較無顯著性差異（P0.05）。 3同期行經尿道電切手術與單純行膀胱腫瘤電切術比較，不會增加術后并發(fā)癥的發(fā)生率。A組患者中有3例出現閉孔神經反射，3例并發(fā)術后出血，2例出現尿路感染，2例并發(fā)尿道狹窄；B組患者中有4例出現閉孔神經反射，2例并發(fā)術后出血，3例出現尿路感染，1例并發(fā)尿道狹窄。兩組患者中均未出現穿孔、尿失禁、TURS、勃起功能障礙等并發(fā)癥。經組間比較，兩組術后并發(fā)癥的發(fā)生率無顯著性差異（P0.05）。 4術后隨訪期內，，A組患者中有7例復發(fā)，平均復發(fā)時間為16.86±7.08個月，其中單發(fā)5例，多發(fā)2例；B組患者中亦有7例復發(fā)，平均復發(fā)時間為18.43±8.00個月，其中單發(fā)4例，多發(fā)3例。經組間比較，兩組術后膀胱腫瘤的復發(fā)率無顯著性差異（P0.05），復發(fā)時間亦無顯著性差異（P0.05）。兩組復發(fā)的膀胱腫瘤均無原位復發(fā)，均未發(fā)現尿道及前列腺窩的種植轉移。復發(fā)的患者再次行經尿道膀胱腫瘤電切術后，隨訪期內均未再復發(fā)。 結論： 1同期施行經尿道電切手術與單純行經尿道膀胱腫瘤電切術相比，不會延長患者的住院時間，但可明顯增加其手術時間、術中出血量及術后膀胱沖洗時間、尿管保留時間。 2同期施行經尿道電切手術與單純行經尿道膀胱腫瘤電切術比較，在解除下尿路梗阻癥狀的同時，不會增加術后并發(fā)癥的發(fā)生率及膀胱腫瘤的復發(fā)率，沒有縮短膀胱腫瘤術后復發(fā)的時間，同時也未發(fā)現有前列腺窩及尿道處的種植轉移。具有安全、療效可靠、減輕患者痛苦和減少治療費用的優(yōu)勢。
[Abstract]:Objective: To investigate the feasibility and efficacy of transurethral resection of bladder tumor combined with benign prostatic hyperplasia (BPH) in patients with bladder tumor and BPH.
Methods: 121 cases of bladder tumor complicated with benign prostatic hyperplasia from March 2009 to March 2013 were retrospectively analyzed. 62 cases underwent transurethral resection of bladder tumor and benign prostatic hyperplasia (group A) and 59 cases underwent transurethral resection of bladder tumor (group B). Objective:To evaluate the feasibility and efficacy of transurethral resection of bladder tumor combined with benign prostatic hyperplasia.
Results: Both groups were successfully completed surgery. Group A was followed up for 9-36 months, with an average of 22.50 months. Group B was followed up for 7-36 months, with an average of 22.75 months.
After 6 months of follow-up, the average I-PSS score and QOL score in group A were significantly different from those before operation (P 0.01); the average I-PSS score and QOL score in group B were not significantly different from those before operation (P 0.05). There was no significant difference in preoperative I-PSS score and QOL score between the two groups (P 0.05). The improvement of urinary symptoms in group A was significantly better than that in group B. There were significant differences in I-PSS score and QOL score between the two groups (P 0.01). Six patients in group B underwent transurethral resection of prostate for benign prostatic hyperplasia during the follow-up period. Symptoms such as frequent micturition, urgency of urination, dysuria and so on were significantly improved compared with those before operation.
The operation time, bleeding volume, bladder irrigation time and urethral retention time in group A were significantly longer than those in group B. The bleeding volume and bladder irrigation time and urethral retention time in group A were significantly longer than those in group B (P 0.01). But there was no significant difference in the length of stay between the two groups (P0.05).
There were 3 cases of obturator nerve reflex, 3 cases of postoperative hemorrhage, 2 cases of urinary tract infection and 2 cases of urethral stricture in group A, 4 cases of obturator nerve reflex, 2 cases of postoperative hemorrhage and 3 cases of postoperative hemorrhage in group B. No complications such as perforation, urinary incontinence, TURS, erectile dysfunction were found in either group. There was no significant difference in the incidence of postoperative complications between the two groups (P 0.05).
During the follow-up period, 7 cases in group A had recurrence, with an average recurrence time of 16.86 (+ 7.08 months), including 5 cases of single recurrence and 2 cases of multiple recurrence; 7 cases in group B had recurrence, with an average recurrence time of 18.43 (+ 8.00 months), including 4 cases of single recurrence and 3 cases of multiple recurrence. There was no significant difference in time between the two groups (P 0.05). There was no recurrence in situ and no implantation metastasis of urethra or prostatic fossa was found in both groups.
Conclusion:
Compared with transurethral resection of bladder tumor, transurethral resection of bladder tumor at the same time did not prolong the hospitalization time, but significantly increased the operation time, intraoperative bleeding volume, bladder irrigation time and urethral retention time.
Compared with transurethral resection of bladder tumor, transurethral resection of bladder tumor at the same time did not increase the incidence of postoperative complications and the recurrence rate of bladder tumor, did not shorten the recurrence time of bladder tumor, and did not find implantation metastasis of prostate fossa and urethra. It has the advantages of safety, reliable curative effect, relieving patient's pain and reducing treatment cost.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.14

【引證文獻】

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1 崔國興;崔國旺;楊磊;石艷波;李世俊;;間苯三酚聯(lián)合托特羅定預防下尿路微創(chuàng)術后膀胱痙攣的療效觀察[J];現代藥物與臨床;2016年11期

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