【摘要】 目的 探討經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生的有效性和安全性。 方法 2008年4月－2009年4月，應用Gyrus超脈沖等離子體行經尿道前列腺腔內逆行剜除汽化切除術124例，前列腺重量為（62.3±21.7） g。術中首先用電切鏡鞘、電切環鈍銳性相結合將前列腺增生腺體沿外科包膜逆行剝離、剜除，同時斷血供，然后推至膀胱頸處后切除。統計手術時間、術中出血量及收集到的前列腺組織質量，術后留置尿管時間、住院時間、手術后前列腺特異性抗原（prostatic specific antigen，PSA）、殘余尿量（post voiding residual volume，PVR）、最大尿流率（Qmax）、國際前列腺癥狀評分（international prostatic symptom scores，IPSS）及生活質量評分（quality of life，QOL）等指標的變化。 結果 124例手術順利完成。手術時間（48.1±19.4） min，腺體組織質量（57.6±19.6） g，平均失血量（86.2±20.7） mL，僅1例需要輸血，出血量和手術時間隨前列腺體積和重量的增加而相應增加和延長。術后留置尿管時間（3.1±1.6） d，住院時間（5.8±1.4） d。隨訪6～18個月，所有患者術后1、6個月Qmax、PVR、IPSS、QOL均較術前得到改善，與術前比較差異均有統計學意義（Plt;0.05）。術后6個月血清PSA降至（0.90±0.26） ng/mL，與術前比較差異有統計學意義（Plt;0.05）。繼發尿道外口狹窄3例，經尿道擴張治療后恢復排尿通暢；繼發尿失禁2例，經保守治療分別于術后1～6個月恢復；無永久性尿失禁、再次手術止血患者，無手術死亡者，未發生經尿道前列腺電切綜合征。 結論 經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生安全有效，值得臨床推廣使用。【Abstract】 Objective To evaluate the safety and clinical efficacy of superpulse plasmakinetic body in transurethral intracavitary retrograde enucleation and vaporization resection of the prostate (TUEVRP) for the treatment of benign prostatic hyperplasia (BPH). Methods Between April 2008 and April 2009, Gyrus TUEVRP was performed on 124 patients with obstructive BPH whose mean prostatic weight was (62.3±21.7) g. The hyperplasia prostate glands were retrogradely dissected and enucleated along surgical capsule to the bladder neck by sharp and blunt dissection combination of the resectoscope tip or loop. Simultaneously, the blood supply of the gland was clamped. The changes of such indexes as operating time, perioperative blood loss, collected prostatic specimen weight, postoperative catheterization time, hospitalization time, prostatic specific antigen (PSA), post voiding residual volume (PVR), maximum urinary flow rate (Qmax), international prostatic symptom score (IPSS), and quality of life (QOL) were assessed. Results All surgeries were successfully carried out with an average operation time of (48.1±19.4) minutes ranged from 25 to 175 minutes. The mean collected prostatic specimen weight was (57.6±19.6) g ranged from 20.2 to 125.7 g. The blood loss was ranged from 45 to 350 ml, averaging at (86.2±20.7) mL during the operation. Blood transfusion was needed in only one case. Blood loss and operation time were increased and prolonged in accordance with the increase of prostatic volume and weight. The postoperative catheterization time was ranged from 2 to 5 days, averaging at 3.1±1.6. The mean hospitalization time was (5.8±1.4) days ranged from 5 to 8 days. All patients were followed up for 6 to 18 months. Qmax, PVR, IPSS and QOL-score six months after operation were significantly improved compared with those before operation (Plt;0.05). There were three cases of external urethral stricture, and they were treated with urethral dilatation successfully. Two cases of urinary incontinence recovered 1 and 6 months later, respectively, by traditional treatment. There were no cases of permanent urinary incontinence, reoperation for hemostasis, operative death, or transurethral resection syndrome. Conclusion TUEVRP is safe and clinically efficacious in the treatment of BPH, and is worthy of clinical promotion.
【摘要】 目的 探討腎移植術后藥物（環孢素A和鈣離子拮抗劑）、口腔衛生與牙齦增生的關系。 方法 隨訪2003年1月—2010年3月間321例腎移植患者，記錄患者術后藥物使用和口腔衛生情況，觀察牙齦增生程度。結果 〖HTSS〗口腔衛生水平與牙齦增生程度之間存在統計學相關性（rs=0.344，P=0.000），口腔衛生水平越差，牙齦增生越嚴重。服用環孢素A和鈣離子拮抗劑患者（A組）牙齦增生發生率為62.15%，高于單純服用環孢素A患者（B組）23.40%，二者比較，差異有統計學意義（χ2=39.220，P=0.000）。結論 〖HTSS〗腎移植術后環孢素A和鈣離子拮抗劑聯合應用明顯增加了牙齦增生的發病率。口腔衛生水平與牙齦增生程度之間存在重要關聯，口腔衛生差是牙齦增生的危險因素。【Abstract】 Objective To investigate the correlation between drugs (cyclosporine A and calcium channel blocker), oral hygiene and gingival hyperplasia in patients after renal transplantation. Methods We continuously followed up 321 patients undergoing renal transplantation from January 2003 to July 2009 in our hospital. The levels of oral hygiene, medication and gingival hyperplasia were recorded. Results There was a close relationship between the level of oral hygiene and the degree of gingival hyperplasia (rs=0.344, P=0.000). Higher grades of gingival hyperplasia (grades Ⅱ and Ⅲ) were found exclusively in patients who did not have good oral hygiene. There was a higher tendency of developing gingival hyperplasia among patients who received cyclosporine A and calcium channel blocker than those who only received cyclosporine A (62.15% vs. 23.40%; χ2=39.220, P=0.000). Conclusion The prevalence of gingival hyperplasia is higher in renal transplant recipients taking cyclosporine A and calcium channel blockers. There is a significant relationship between the level of oral hygiene and the development of gingival hyperplasia. Poor oral hygiene is a risk factor of gingival hyperplasia.