Effect of transurethral plasma bipolar resection of prostate on urodynamics and serum levels of prostate specific antigen, epidermal growth factor and prostaglandin E2 in patients with benign prostatic hyperplasia
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摘要:目的 探讨经尿道前列腺等离子双极电切术对良性前列腺增生(BPH)患者尿动力学及血清前列腺特异抗原(PSA)、表皮生长因子(EGF)、前列腺素E2(PGE2)水平的影响。方法 选取BPH患者150例，按治疗方案分为试验组(n=76)与对照组(n=74)。对照组予以经尿道前列腺汽化电切术，试验组予以经尿道前列腺等离子双极电切术。比较2组手术情况、并发症发生率与术前、术后1周血清PSA、EGF、PGE2水平。术后随访6个月，比较2组术前、术后6个月尿动力学指标[残余尿量(PVR)、最大尿流率(Qmax)、膀胱顺应性(BC)]水平、国际前列腺症状评分(IPSS)、生活质量评分(SF-36)。结果 2组手术时间相比，差异无统计学意义(P>0.05)。试验组术中出血量、术后3 d VAS评分、尿管留置时间、住院时间显著优于对照组(P < 0.05)。试验组并发症发生率显著低于对照组(P < 0.05)。术后1周, 2组血清PSA、EGF、PGE2水平均较术前显著降低，且试验组显著低于对照组(P < 0.05)。术后6个月, 2组PVR水平、Qmax、BC水平均较术前显著改善，且试验组显著优于对照组(P < 0.05)。术后6个月, 2组IPSS评分、SF-36评分均较术前显著改善，且试验组显著优于对照组(P < 0.05)。结论 经尿道前列腺等离子双极电切术能减轻BPH患者手术创伤，减少并发症发生，改善尿流动力学，降低血清PSA、EGF、PGE2水平，提高生活质量。Abstract:Objective To explore the effects of transurethral plasma bipolar resection of prostate on urodynamics and serum levels of prostate specific antigen (PSA), epidermal growth factor (EGF) and prostaglandin E2 (PGE2) in patients with benign prostatic hyperplasia (BPH).Methods Totally 150 patients with BPH were selected and divided into experimental group (n=76) and control group (n=74) according to treatment schemes. The control group was treated with transurethral vaporization resection of the prostate, and the experimental group was treated with transurethral plasma bipolar resection of the prostate. The levels of serum PSA, EGF and PGE2 were compared between the two groups before treatment and 1 week after operation. The patients were followed up for 6 months. The urodynamic indexes [residual urine volume (PVR), maximum urinary flow rate (Qmax), bladder compliance (BC), International Prostate Symptom Score (IPSS) and quality of life score (SF-36)] were compared before treatment and 6 months after operation.Results There was no significant difference in operation time between the two groups (P>0.05). The bleeding volume, VAS score at 3 days after operation in the experimental group were significantly lower than those in the control group, and the indwelling time of urinary catheter and hospitalization time were significantly shorter than those in the control group (P < 0.05). The incidence rate of complications in the experimental group was 7.89%, which was significantly lower than 25.68% in the control group (P < 0.05). The levels of serum PSA, EGF and PGE2 in the first week after operation were significantly lower than those before operation in both groups, and those in the experimental group were significantly lower than the control group (P < 0.05). Six months after operation, the levels of PVR, Qmax and BC in both groups significantly improved when compared with those before operation, and those in the experimental group were significantly better than the control group (P < 0.05). Six months after operation, IPSS and SF-36 scores in both groups significantly improved when compared with those before operation, and those in the experimental group were significantly better than the control group (P < 0.05).Conclusion Transurethral plasma bipolar resection of prostate can reduce surgical trauma, reduce incidence of complications, improve urodynamics, reduce serum levels of PSA, EGF and PGE2, and improve quality of life.
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表 1 2组患者一般资料比较(x±s)[n(%)]
组别 年龄/岁 体质量/kg 病程/年 前列腺体积/mm3 合并症 慢阻肺 糖尿病 高血压 试验组(n=76) 63.69±5.08 61.34±4.52 4.29±1.21 62.26±9.74 7(9.21) 11(14.47) 19(25.00) 对照组(n=74) 62.72±5.47 60.58±4.70 4.37±1.08 63.17±8.61 9(12.16) 12(16.22) 21(28.38) 
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表 2 2组手术情况比较(x±s)
组别 n 手术时间/min 术中出血量/mL 术后3 d VAS评分/分 尿管留置时间/d 住院时间/d 试验组 76 47.05±12.48 69.36±18.52* 4.28±0.90* 3.14±0.83* 5.74±1.26* 对照组 74 49.64±11.79 86.05±20.19 5.92±1.46 5.08±1.37 7.30±1.69 与对照组比较, *P < 0.05。
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表 3 2组并发症发生率比较[n(%)]
组别 n 尿道狭窄 膀胱痉挛 尿失禁 包膜穿孔 继发性出血 电切综合征 总计 试验组 76 2(2.63) 0 2(2.63) 1(1.32) 1(1.32) 0 6(7.89)* 对照组 74 4(5.41) 2(2.70) 5(6.76) 3(4.05) 4(5.41) 1(1.35) 19(25.68) 与对照组比较, *P < 0.05。
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表 4 2组血清PSA、EGF、PGE2水平比较(x±s)
时点 组别 PSA/(mg/L) EGF/(pg/mL) PGE2/(ng/mL) 术前 试验组(n=76) 18.72±3.85 47.12±6.16 2.42±0.27 对照组(n=74) 18.59±2.97 48.36±6.09 2.49±0.31 术后1周 试验组(n=76) 1.96±0.39*# 24.14±7.28*# 0.84±0.16*# 对照组(n=76) 3.68±0.64* 30.75±6.43* 1.17±0.25* PSA: 前列腺特异抗原; EGF: 表皮生长因子; PGE2: 前列腺素E2。与术前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 5 2组尿动力学情况比较(x±s)
时间 组别 PVR/mL Qmax/(mL/s) BC/(mL/cmH2O) 术前 试验组(n=76) 79.52±12.86 7.90±1.71 14.03±5.42 对照组(n=74) 80.81±11.92 7.63±1.94 13.79±6.08 术后6个月 试验组(n=76) 19.48±4.02*# 19.67±3.29*# 29.41±4.27*# 对照组(n=76) 25.97±5.40* 15.16±2.35* 25.52±3.93* PVR: 残余尿量; Qmax: 最大尿流率; BC: 膀胱顺应性。与术前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 6 2组IPSS、SF-36评分比较(x±s)
分 组别 n IPSS SF-36 术前 术后6个月 术前 术后6个月 试验组 76 24.90±3.75 5.03±1.21*# 50.71±6.28 84.06±8.54*# 对照组 74 25.24±3.52 7.68±1.63* 49.96±5.75 76.37±7.60* IPSS: 国际前列腺症状评分; SF-36: 健康调查简表。与术前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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