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Transurethral Electrovapor Resection Treatment for Large Prostates: A 2-Year Follow-Up Study

以Wedge Loop施行經尿道汽化切除手術治療較大型的攝護腺:兩年之追蹤研究

摘要


目的:以Wedge Loop施行經尿道汽化切除手術與傳統經尿道切除手術治療較大型攝護腺安全性與成效之研究。 病人及方法:1998年1月起至2002年6月,總共有161位攝護腺體積大於40立方公分之攝護腺肥大症合併排尿障礙病患,隨機分成兩組進行以Wedge Loop施行經尿道汽化切除手術或傳統經尿道切除手術。手術間之指標包括手術時間、血紅素變化、沖洗量、切除之攝護腺重量、導尿管留置時間、住院時間、輸血與否以及經尿道切除症候群等;也比較術後再置管率與再住院率。治療成效指標以IPSS, QOL評量表、最大尿流率與餘尿量等評估。不良作用有性功能障礙、尿道狹窄、尿失禁與再治療率(藥物治療或再手術)等作二年追蹤。 結果:兩組間的平均手術時間、血紅素變化、沖洗液量、切除之攝護腺重量、導尿管留置時間與住院時間有顯著意義;而輸血、經尿道切除症候群、再置管率與再住院率無明顯差異。術後成效指標如IPSS、QOL、最大尿流率與餘尿量等,較之術前有顯著意義;然而,追蹤至術後二年,二組之間無明顯差異。性功能障礙、尿道狹窄、尿失禁與再治療率也無顯著意義。 結論:以Wedge Loop施行經尿道汽化切除手術可減少手術時間、出血量、沖洗液量、尿管留置時間與術後住院時間,追蹤二年之成效與傳統經尿道切除攝護腺手術無異;或可成為手術治療攝護腺體積大於40立方公分之另一選擇。

並列摘要


Objective: To study the safety and efficacy of transurethral electrovapor resection (TUVRP) using a Wedge Loop versus standard transurethral resection (TURP) treatment for patients with a large prostate. Patients and Methods: One hundred and sixty-one symptomatic benign prostatic hyperplasia (BPH) patients with a prostate size > 40 ml were randomized and underwent either TUVRP or TURP. The perioperative parameters including operation time, change in hemoglobin level, intraoperative irrigant amount, resected prostate weight, duration of catheterization, length of postoperative stay, incidences of blood transfusion, transurethral resection syndrome, recatheterization, and readmission were compared. All patients were assessed preoperatively with the International Prostate Symptom Score (IPSS), disease specific quality of life (QOL) assessment score, prostate volume, peak urinary flow Q(subscript max) with post-void residual (PVR) volume measurement, and a sexual-function questionnaire. Patients were followed up 3, 6, 12, and 24 months after surgery, followed by a comparison of incidences of sexual dysfunction, complications, and re-treatment. Results: A significantly shorter operation time, a smaller decrease in serum hemoglobin levels, a shorter catheterization time, a reduced postoperative hospital stay, and reduced hospitalization costs (p<0.001) were observed in the TUVRP group compared to the TURP group. However, no differences were noted between the TUVRP and TURP groups with respect to average IPSS, QOL assessment score, Q(subscript max), and PVR (p=0.92, 057, 0.79, and 0.58, respectively), as well as the incidences of sexual dysfunction, urethral stricture, urinary incontinence, and need for medical retreatment and reoperation (p=0.67, 1.0, 0.61, and 1.0, respectively) after 2 years of follow-up. Conclusions: Our 2-year follow-up results suggest that both TUVRP and TURP offer comparable treatment outcomes for patients with a large prostate. However, the former demonstrated better perioperative results.

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