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中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 152 -156. doi: 10.3877/cma.j.issn.1674-3253.2024.02.006

临床研究

保护射精技术在前列腺等离子剜除术中的应用
汪洋1, 李志鹏2, 张楠1, 何海填1, 杨伟锋1, 张焕灵1, 王可兵1,()   
  1. 1. 518000 广东,深圳市前海蛇口自贸区医院泌尿外科
    2. 650000 云南,昆明医科大学第二附属医院泌尿外科
  • 收稿日期:2023-05-16 出版日期:2024-04-01
  • 通信作者: 王可兵
  • 基金资助:
    深圳市南山区科技计划项目(NS2021098)

Ejaculation-preserving technique in transurethral plasmakinetic enucleation of the prostate

Yang Wang1, Zhipeng Li2, Nan Zhang1, Haitian He1, Weifeng Yang1, Huanling Zhang1, Kebing Wang1,()   

  1. 1. Department of Urology, Qianhai Shekou Free Trade Zone Hospital, Shenzhen 518000, China
    2. Department of Urology, the Second Hospital Affiliated to Kunming Medical University, Kunming 650000, China
  • Received:2023-05-16 Published:2024-04-01
  • Corresponding author: Kebing Wang
引用本文:

汪洋, 李志鹏, 张楠, 何海填, 杨伟锋, 张焕灵, 王可兵. 保护射精技术在前列腺等离子剜除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(02): 152-156.

Yang Wang, Zhipeng Li, Nan Zhang, Haitian He, Weifeng Yang, Huanling Zhang, Kebing Wang. Ejaculation-preserving technique in transurethral plasmakinetic enucleation of the prostate[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(02): 152-156.

目的

探讨保护射精技术在前列腺等离子剜除术中的应用效果。

方法

分析2015年6月至2022年9月在深圳市前海蛇口自贸区医院及昆明医科大学第二附属医院行经尿道前列腺等离子剜除术治疗的106例具有正常射精功能的前列腺增生患者临床资料,术中均保留了精阜近端及两侧1 cm范围内的组织和黏膜。观察患者手术时间、膀胱冲洗时间、留置导尿时间、术后住院天数、手术并发症发生情况,术前和术后1、6个月的患者国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、膀胱残余尿量(PVR)、国际勃起功能评分(IIEF-5)和术后6个月患者逆行射精比例。

结果

106例患者均成功完成手术,无中转开放手术。手术时间36~115 min,平均(66±12)min;膀胱冲洗时间0~46 h,平均(29.3±2.8)h;留置尿管时间2~5 d,平均(3.8±0.7)d;术后住院天数3~7 d,平均(4.1±1.2)d。术后1、6个月患者Qmax、PVR、IPSS和QOL均较术前有明显改善(P<0.001),IIEF-5较术前无明显变化(P>0.05);术后6个月106例患者射精量不变、减少、消失的例数分别为89例(83.96%)、6例(5.66%)、11例(10.38%)。术后有13例(12.26%)出现短暂性尿失禁,经提肛锻炼后1个月内控尿恢复正常。术中无大出血、无直肠和膀胱损伤病例,术后无输血、无尿道狭窄等并发症。

结论

经尿道前列腺等离子剜除术中采用保护射精技术不仅可缓解前列腺增生患者的临床症状,同时可有效的保护射精功能、减少术后逆行射精的比例,值得推广应用。

Objective

To explore the effectiveness of ejaculation-preserving technique to transurethral plasmakinetic enucleation of the prostate (PKEP).

Methods

A total of 106 patients with suffificient ejaculate of BPH underwent PKEP from June 2015 to September 2022 in Qianhai Shekou Free Trade Zone Hospital and the Second Hospital Affiliated to Kunming Medical University, paracollicular and supracollicular tissue nearly 1cm proximal to the verumontanum was preserved. Operative time, bladder irrigation time, catheter indwelling time, postoperative hospital stay time and peri-operative complications were recorded. International prostatic symptom score (IPSS), quality of life (QOL) score, postvoid residual urine vo1ume (PVR), International Index of Erectile Function 5 (IIEF-5), maximum flow rate (Qmax) were measured preoperatively, 1 and 6 months postoperatively, rate of ejaculation preservation were also recorded.

Results

All of the 106 cases were operated successfully and none of them converted to open surgery. The mean operating time, bladder irrigation time, catheter indwelling time and postoperative hospital stay were (66±12) min, (29.3±2.8) h, (3.8±0.7) d, (4.1±1.2) d, respectively. C1inical outcomes(IPSS, QOL score, Qmax and PVR) showed significantly improvement from baseline (P<0.001), there were no significant changes in IIEF-5 (P>0.05). Ejaculation volume was unchanged, decreased or vanished in 89(83.96%), 6(5.66%) and 11(10.38%) case, respectively. No severe complications were observed.

Conclusion

Ejaculation-preserving technique in PKEP can not only relieve the clinical symptoms of BPH patients, but also effectively reduce the proportion of retrograde ejaculation after surgery, which is worthy of popularization and application.

图1 保留射精功能的前列腺剜除术与传统前列腺剜除术示意图注:a示传统的前列腺剜除术,所有前列腺组织均被剜除;b示保护射精技术的前列腺剜除术,保留射精罩即精阜近端及两侧1cm范围内的组织(EH为射精罩,PC为前列腺包膜,Ve为精阜,BN为膀胱颈)
表1 106例前列腺增生(BPH)患者手术前后Qmax、PVR、IPSS评分、QOL评分和IIEF-5比较(±s)
表2 106例BPH患者术前、术后6个月射精情况[例(%)]
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