Трехлетний опыт лечения больных доброкачественной гиперплазией простаты: от открытой операции к биполярной энуклеации
DOI:
https://doi.org/10.25726/NM.2019.48.73.005Ключевые слова:
доброкачественная гиперплазия простаты, биполярная трансуретральная энуклеация простаты, хирургия, методы, простата, пациентыАннотация
В статье представлен опыт внедрения нового метода лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) - трансуретральной биполярной энуклеации простаты (ТУЭБ) в арсенал хирургических методов урологического отделения "Клинической больницы "РЖД - Медицина" г. Саратов. Статистические данные по контролю были получены ретроспективным методом из архива историй болезни. Статистическую обработку результатов исследования проводили при помощи параметрического критерия t Стьюдента. Различия показателей считались достоверными при уровне значимости р ≤ 0,05.
Анализ общих операционных результатов и клинической эффективности нового метода (89 чел.) проведен в сравнении с ретроспективными данными по методу открытой простатэктомии (ОПЭ - 91 чел.), ранее применявшегося в отделении для лечения пациентов данного профиля.
Установлено, что применение ТУЭБ вместо ОПЭ при средних и больших объемах ДГПЖ позволяет в 2-3 раза снизить кровопотерю во время операции, сроки послеоперационного дренирования мочевого пузыря и общую продолжительность госпитализации при минимальном количестве интра- и послеоперационных кровотечений и при отсутствии осложнений инфекционно-воспалительного характера.
Полученные результаты свидетельствуют о перспективности применения ТУЭБ вместо травматичной ОПЭ, так как это позволяет оптимизировать хирургические результаты и экономические показатели лечения ДГПЖ.
Библиографические ссылки
1. Apolikhin O.I., Sevryukov F.A., Sorokin D.A., Karpukhin I.V., Puchkin A.B., Semenychev D.V., Kochkin A.D. (2013). Dinamika i prognozy zabolevaemosti dobrokachestvennoj giperplaziej predstatel'noj zhelezy v Nizhegorodskoj oblasti [Dynamics and forecasts of the incidence of benign prostatic hyperplasia in the Nizhny Novgorod region]. Jeksperimental'naja i klinicheskaja urologija [Experimental and clinical urology], 3, 4-7. (In Russ.)
2. Apolikhin O.I., Sivkov A.V., Moskaleva N.G., Solntseva T.V., Komarova V.A. (2014). Analiz urologicheskoj zabolevaemosti i smertnosti v Rossijskoj Federacii za desjatiletnij period (2002–2012) [Analysis of urological morbidity and mortality in the Russian Federation over a ten-year period (2002-2012)]. Jeksperimental'naja i klinicheskaja urologija [Experimental and clinical urology], 2, 4-12. (In Russ.)
3. Vertkin A. L., Polosyants O. B., Keshokov R. Kh. (2008). Dobrokachestvennaja giperplazija predstatel'noj zhelezy i ee oslozhnenija v obshhemedicinskoj praktike [Benign prostatic hyperplasia and its complications in general medical practice]. Consilium Medicum, 4(4), 14-22. (In Russ.)
4. Kalininskaya A.A., Mashin A.G., Sevryukov F.A. (2013). Faktory riska razvitija giperplazii predstatel'noj zhelezy [Risk factors for developing prostatic hyperplasia]. Social'nye aspekty zdorov'ja naselenija [Social aspects of public health], 29(1), 1-9. (In Russ.)
5. Kamalov A.A., Sevryukov F.A. (2012). Izuchenie jeffektivnosti bipoljarnoj transuretral'noj rezekcii adenomy prostaty srednih i malyh razmerov [Study of the effectiveness of bipolar transurethral resection of adenomas of the prostate of medium and small sizes]. Sovremennye tehnologii v medicine [Modern technologies in medicine], 4, 68-72. (In Russ.)
6. Kamyshov S.V., Nishanov D.A., Pulatov D.A., Yuldasheva N.Sh. (2017). Izuchenie markerov apoptoza, proliferacii i angiogeneza u bol'nyh rakom jaichnika, poluchivshih soprovoditel'nuju immunoterapiju [The study of markers of apoptosis, proliferation and angiogenesis in patients with ovarian cancer who received accompanying immunotherapy]. Zlokachestvennye opuholi [Malignant tumors], 1, 84-91. (In Russ.)
7. Kamyshov S.V., Pulatov D.A., Nishanov D.A., Yuldasheva N.Sh., Yusupova N.B. (2017). Znachimost' ocenki molekuljarno-biologicheskih onkomarkerov v soprovoditel'noj immunoterapii pri rake shejki matki [Significance of the assessment of molecular biological tumor markers in accompanying immunotherapy for cervical cancer]. Onkologija i radiologija Kazahstana [Oncology and radiology of Kazakhstan], 2, 45-48. (In Russ.)
8. Kamyshov S.V., Pulatov D.A., Yuldasheva N.Sh. (2017). Ispol'zovanie metodov gravitacionnoj hirurgii krovi v kompleksnom lechenii bol'nyh rakom jaichnika [The use of gravitational blood surgery methods in the complex treatment of patients with ovarian cancer]. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova [Bulletin of the National Medical and Surgical Center after N.I. Pirogov], 12(1), 52-56. (In Russ.)
9. Kamyshov S.V., Yuldasheva N.Sh., Salimova L.R. 2010. Vozmozhnosti ispol'zovanija jekstrakorporal'noj immunofarmakoterapii v kombinirovannom lechenii raka shejki matki [Possibilities of using extracorporeal immunopharmacotherapy in the combined treatment of cervical cancer]. Onkologija i radiologija Kazahstana [Oncology and radiology of Kazakhstan], 3-4 (16-17), 95-96. (In Russ.)
10. Kovshik V.S., Savrova O.B. (2017). Sravnitel'nyj analiz faktorov riska razvitija raka predstatel'noj zhelezy [Comparative analysis of risk factors for prostate cancer]. Jelektronnyj nauchno-obrazovatel'nyj vestnik. Spec. vypusk «Zdorov'e i obrazovanie v XXI veke» [Electron. scientific and educational bulletin. Specialist. issue "Health and education in the XXI century"], 19 (2), 135-136. (In Russ.)
11. Kulikova N.G., Kamurzoeva S.Sh. (2014). Mediko-social'nye osobennosti bol'nyh trudosposobnogo vozrasta s pervichnoj invalidnost'ju [Medical and social characteristics of patients of working age with primary disability]. Problemy social'noj gigieny, zdravoohranenija i istorii mediciny [Problems of social hygiene, health care and the history of medicine], 22(2), 14-16. (In Russ.)
12. Pulatov D.A., Ibragimov Zh.M., Kamyshov S.V. (2017). Sravnitel'naja ocenka toksichnosti lechenija bol'nyh himiorezistentnym kolorektal'nym rakom [Comparative evaluation of the toxicity of treatment of patients with chemoresistant colorectal cancer]. Onkologija i radiologija Kazahstana [Oncology and radiology of Kazakhstan], 2, 58-61. (In Russ.)
13. Sevryukov F.A. (2012). Kachestvo zhizni bol'nyh posle transuretral'noj jenukleacii adenomy predstatel'noj zhelezy bol'shih razmerov [The quality of life of patients after transurethral enucleation of large prostate adenomas]. Andrologija i genital'naja hirurgija [Andrology and genital surgery], 13(3), 42-46. (In Russ.)
14. Sevryukov F.A., Kamaev I.A., Mushroom M.N., Perevezentsev E.A. (2011). Osnovnye aspekty obespechenija vysokokvalificirovannoj urologicheskoj medicinskoj pomoshh'ju bol'nyh s dobrokachestvennoj giperplaziej predstatel'noj zhelezy [The main aspects of providing highly qualified urological medical care to patients with benign prostatic hyperplasia]. Rossijskij mediko-biologicheskij vestnik imeni akademika I.P. Pavlova [I.P. Pavlov Russian Medical Biological Herald], 19(1), 109-113. (In Russ.)
15. Sevryukov F.A., Kamaev I.A., Mushroom M.N., Perevezentsev E.A., Malinina O.Yu., Elina Yu.A. (2011). Faktory riska i kachestvo zhizni bol'nyh s dobrokachestvennoj giperplaziej predstatel'noj zhelezy [Risk factors and quality of life in patients with benign prostatic hyperplasia]. Rossijskij mediko-biologicheskij vestnik imeni akademika I.P. Pavlova [I.P. Pavlov Russian Medical Biological Herald], 3, 48-52. (In Russ.)
16. Sevryukov F.A., Kochkin A.D., Sorokin D.A., Semenychev D.V., Knutov A.V. (2015). Bipoljarnaja transuretral'naja jenukleacija gigantskoj adenomy prostaty [Bipolar transurethral enucleation of giant prostate adenoma]. Tihookeanskij medicinskij zhurnal [Pacific Medical Journal], 4, 72-74. (In Russ.)
17. Sevryukov F.A., Malinina O.Yu., Elina Yu.A. (2011). Osobennosti medicinskogo obespechenija pacientov s dobrokachestvennoj giperplaziej predstatel'noj zhelezy na jetape ambulatorno-poliklinicheskoj pomoshhi [Features of medical support for patients with benign prostatic hyperplasia at the stage of outpatient care]. Medicinskij al'manah [Medical almanac], 1, 25-27. (In Russ.)
18. Sevryukov F.A., Puchkin A.B., Krupin V.N., Chebykin A.V., Sorokin D.A., Karpukhin I.V., Malinina O.Yu., Zorin D.G. (2007). Transuretral'naja jelektrohirurgija novogo pokolenija (TURIS) v lechenii zabolevanij nizhnih mochevyh putej i prostaty [New Generation Transurethral Electrosurgery (TURIS) in the treatment of diseases of the lower urinary tract and prostate]. Urologija [Urology], 3, 28-35. (In Russ.)
19. Semenychev D.V., Sevryukov F.A., Sorokin D.A., Karpukhin I.V., Puchkin A.B., Kochkin A.D., Knutov A.V. (2015). Sravnitel'naja ocenka bipoljarnoj transuretral'noj vaporezekcii (TUVRB) i bipoljarnoj rezekcii (TURIS) v lechenii dobrokachestvennoj giperplazii prostaty [Comparative evaluation of bipolar transurethral vapor resection (TUVRB) and bipolar resection (TURIS) in the treatment of benign prostatic hyperplasia]. Medicinskij vestnik Bashkortostana [Medical Bulletin of Bashkortostan], 10(3), 16-19. (In Russ.)
20. Sivkov A.B. (2010). Dobrokachestvennaja giperplazija predstatel'noj zhelezy: personal'nyj vzgljad [Benign prostatic hyperplasia: personal view]. Urologija segodnja [Urology today], 6, 7-11. (In Russ.)
21. Alyaeva P.V. Glybochko D.Yu., Pushkarja D.Ju. (eds.) (2016). Urologija. Rossijskie klinicheskie rekomendacii [Urology. Russian Clinical Recommendations]. Moscow: GEOTAR-Media, 496.
22. Khamurzoeva S.Sh., Kulikova N.G. (2013). Puti snizhenija invalidnosti u lic trudosposobnogo vozrasta [Ways to reduce disability in people of working age]. Problemy social'noj gigieny, zdravoohranenija i istorii mediciny [Problems of social hygiene, health care and the history of medicine], 6, 29-31.
23. Chen S., Zhu L, Cai J, Zheng Z, Ge R, Wu M, et al. (2014). Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: A randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol., 66, 284-291.
24. da Silva R.D., Bidikov L., Michaels W. et al. (2015). Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol, 22 Suppl 1, 30-44.
25. Gratzke C. et al. (2015). EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Simptoms including Benign Prostatic Obstruction. European Urology, 67(6), 1099-1109.
26. Geavlete B., Stanescu F., Iacoboaie C., Geavlete P. (2013). Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases. A medium term, prospective, randomized comparison. BJU Int., 111(5), 793-803.
27. Li M., Qiu J., Hou Q. et al. (2015). Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One, 10(3), e0121265.
28. Ou R.B., Deng X.R., Yang W.J., Wei X.H., Chen H., Xie K.J. (2013). Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes > 80mL: a prospective randomized study. BJU Int., 112, 239-245.
29. Qiu J., Hou Q. et al. (2015). Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One, 10(3), e0121265.
2. Apolikhin O.I., Sivkov A.V., Moskaleva N.G., Solntseva T.V., Komarova V.A. (2014). Analiz urologicheskoj zabolevaemosti i smertnosti v Rossijskoj Federacii za desjatiletnij period (2002–2012) [Analysis of urological morbidity and mortality in the Russian Federation over a ten-year period (2002-2012)]. Jeksperimental'naja i klinicheskaja urologija [Experimental and clinical urology], 2, 4-12. (In Russ.)
3. Vertkin A. L., Polosyants O. B., Keshokov R. Kh. (2008). Dobrokachestvennaja giperplazija predstatel'noj zhelezy i ee oslozhnenija v obshhemedicinskoj praktike [Benign prostatic hyperplasia and its complications in general medical practice]. Consilium Medicum, 4(4), 14-22. (In Russ.)
4. Kalininskaya A.A., Mashin A.G., Sevryukov F.A. (2013). Faktory riska razvitija giperplazii predstatel'noj zhelezy [Risk factors for developing prostatic hyperplasia]. Social'nye aspekty zdorov'ja naselenija [Social aspects of public health], 29(1), 1-9. (In Russ.)
5. Kamalov A.A., Sevryukov F.A. (2012). Izuchenie jeffektivnosti bipoljarnoj transuretral'noj rezekcii adenomy prostaty srednih i malyh razmerov [Study of the effectiveness of bipolar transurethral resection of adenomas of the prostate of medium and small sizes]. Sovremennye tehnologii v medicine [Modern technologies in medicine], 4, 68-72. (In Russ.)
6. Kamyshov S.V., Nishanov D.A., Pulatov D.A., Yuldasheva N.Sh. (2017). Izuchenie markerov apoptoza, proliferacii i angiogeneza u bol'nyh rakom jaichnika, poluchivshih soprovoditel'nuju immunoterapiju [The study of markers of apoptosis, proliferation and angiogenesis in patients with ovarian cancer who received accompanying immunotherapy]. Zlokachestvennye opuholi [Malignant tumors], 1, 84-91. (In Russ.)
7. Kamyshov S.V., Pulatov D.A., Nishanov D.A., Yuldasheva N.Sh., Yusupova N.B. (2017). Znachimost' ocenki molekuljarno-biologicheskih onkomarkerov v soprovoditel'noj immunoterapii pri rake shejki matki [Significance of the assessment of molecular biological tumor markers in accompanying immunotherapy for cervical cancer]. Onkologija i radiologija Kazahstana [Oncology and radiology of Kazakhstan], 2, 45-48. (In Russ.)
8. Kamyshov S.V., Pulatov D.A., Yuldasheva N.Sh. (2017). Ispol'zovanie metodov gravitacionnoj hirurgii krovi v kompleksnom lechenii bol'nyh rakom jaichnika [The use of gravitational blood surgery methods in the complex treatment of patients with ovarian cancer]. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova [Bulletin of the National Medical and Surgical Center after N.I. Pirogov], 12(1), 52-56. (In Russ.)
9. Kamyshov S.V., Yuldasheva N.Sh., Salimova L.R. 2010. Vozmozhnosti ispol'zovanija jekstrakorporal'noj immunofarmakoterapii v kombinirovannom lechenii raka shejki matki [Possibilities of using extracorporeal immunopharmacotherapy in the combined treatment of cervical cancer]. Onkologija i radiologija Kazahstana [Oncology and radiology of Kazakhstan], 3-4 (16-17), 95-96. (In Russ.)
10. Kovshik V.S., Savrova O.B. (2017). Sravnitel'nyj analiz faktorov riska razvitija raka predstatel'noj zhelezy [Comparative analysis of risk factors for prostate cancer]. Jelektronnyj nauchno-obrazovatel'nyj vestnik. Spec. vypusk «Zdorov'e i obrazovanie v XXI veke» [Electron. scientific and educational bulletin. Specialist. issue "Health and education in the XXI century"], 19 (2), 135-136. (In Russ.)
11. Kulikova N.G., Kamurzoeva S.Sh. (2014). Mediko-social'nye osobennosti bol'nyh trudosposobnogo vozrasta s pervichnoj invalidnost'ju [Medical and social characteristics of patients of working age with primary disability]. Problemy social'noj gigieny, zdravoohranenija i istorii mediciny [Problems of social hygiene, health care and the history of medicine], 22(2), 14-16. (In Russ.)
12. Pulatov D.A., Ibragimov Zh.M., Kamyshov S.V. (2017). Sravnitel'naja ocenka toksichnosti lechenija bol'nyh himiorezistentnym kolorektal'nym rakom [Comparative evaluation of the toxicity of treatment of patients with chemoresistant colorectal cancer]. Onkologija i radiologija Kazahstana [Oncology and radiology of Kazakhstan], 2, 58-61. (In Russ.)
13. Sevryukov F.A. (2012). Kachestvo zhizni bol'nyh posle transuretral'noj jenukleacii adenomy predstatel'noj zhelezy bol'shih razmerov [The quality of life of patients after transurethral enucleation of large prostate adenomas]. Andrologija i genital'naja hirurgija [Andrology and genital surgery], 13(3), 42-46. (In Russ.)
14. Sevryukov F.A., Kamaev I.A., Mushroom M.N., Perevezentsev E.A. (2011). Osnovnye aspekty obespechenija vysokokvalificirovannoj urologicheskoj medicinskoj pomoshh'ju bol'nyh s dobrokachestvennoj giperplaziej predstatel'noj zhelezy [The main aspects of providing highly qualified urological medical care to patients with benign prostatic hyperplasia]. Rossijskij mediko-biologicheskij vestnik imeni akademika I.P. Pavlova [I.P. Pavlov Russian Medical Biological Herald], 19(1), 109-113. (In Russ.)
15. Sevryukov F.A., Kamaev I.A., Mushroom M.N., Perevezentsev E.A., Malinina O.Yu., Elina Yu.A. (2011). Faktory riska i kachestvo zhizni bol'nyh s dobrokachestvennoj giperplaziej predstatel'noj zhelezy [Risk factors and quality of life in patients with benign prostatic hyperplasia]. Rossijskij mediko-biologicheskij vestnik imeni akademika I.P. Pavlova [I.P. Pavlov Russian Medical Biological Herald], 3, 48-52. (In Russ.)
16. Sevryukov F.A., Kochkin A.D., Sorokin D.A., Semenychev D.V., Knutov A.V. (2015). Bipoljarnaja transuretral'naja jenukleacija gigantskoj adenomy prostaty [Bipolar transurethral enucleation of giant prostate adenoma]. Tihookeanskij medicinskij zhurnal [Pacific Medical Journal], 4, 72-74. (In Russ.)
17. Sevryukov F.A., Malinina O.Yu., Elina Yu.A. (2011). Osobennosti medicinskogo obespechenija pacientov s dobrokachestvennoj giperplaziej predstatel'noj zhelezy na jetape ambulatorno-poliklinicheskoj pomoshhi [Features of medical support for patients with benign prostatic hyperplasia at the stage of outpatient care]. Medicinskij al'manah [Medical almanac], 1, 25-27. (In Russ.)
18. Sevryukov F.A., Puchkin A.B., Krupin V.N., Chebykin A.V., Sorokin D.A., Karpukhin I.V., Malinina O.Yu., Zorin D.G. (2007). Transuretral'naja jelektrohirurgija novogo pokolenija (TURIS) v lechenii zabolevanij nizhnih mochevyh putej i prostaty [New Generation Transurethral Electrosurgery (TURIS) in the treatment of diseases of the lower urinary tract and prostate]. Urologija [Urology], 3, 28-35. (In Russ.)
19. Semenychev D.V., Sevryukov F.A., Sorokin D.A., Karpukhin I.V., Puchkin A.B., Kochkin A.D., Knutov A.V. (2015). Sravnitel'naja ocenka bipoljarnoj transuretral'noj vaporezekcii (TUVRB) i bipoljarnoj rezekcii (TURIS) v lechenii dobrokachestvennoj giperplazii prostaty [Comparative evaluation of bipolar transurethral vapor resection (TUVRB) and bipolar resection (TURIS) in the treatment of benign prostatic hyperplasia]. Medicinskij vestnik Bashkortostana [Medical Bulletin of Bashkortostan], 10(3), 16-19. (In Russ.)
20. Sivkov A.B. (2010). Dobrokachestvennaja giperplazija predstatel'noj zhelezy: personal'nyj vzgljad [Benign prostatic hyperplasia: personal view]. Urologija segodnja [Urology today], 6, 7-11. (In Russ.)
21. Alyaeva P.V. Glybochko D.Yu., Pushkarja D.Ju. (eds.) (2016). Urologija. Rossijskie klinicheskie rekomendacii [Urology. Russian Clinical Recommendations]. Moscow: GEOTAR-Media, 496.
22. Khamurzoeva S.Sh., Kulikova N.G. (2013). Puti snizhenija invalidnosti u lic trudosposobnogo vozrasta [Ways to reduce disability in people of working age]. Problemy social'noj gigieny, zdravoohranenija i istorii mediciny [Problems of social hygiene, health care and the history of medicine], 6, 29-31.
23. Chen S., Zhu L, Cai J, Zheng Z, Ge R, Wu M, et al. (2014). Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: A randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol., 66, 284-291.
24. da Silva R.D., Bidikov L., Michaels W. et al. (2015). Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol, 22 Suppl 1, 30-44.
25. Gratzke C. et al. (2015). EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Simptoms including Benign Prostatic Obstruction. European Urology, 67(6), 1099-1109.
26. Geavlete B., Stanescu F., Iacoboaie C., Geavlete P. (2013). Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases. A medium term, prospective, randomized comparison. BJU Int., 111(5), 793-803.
27. Li M., Qiu J., Hou Q. et al. (2015). Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One, 10(3), e0121265.
28. Ou R.B., Deng X.R., Yang W.J., Wei X.H., Chen H., Xie K.J. (2013). Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes > 80mL: a prospective randomized study. BJU Int., 112, 239-245.
29. Qiu J., Hou Q. et al. (2015). Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One, 10(3), e0121265.
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Опубликован
2018-12-25
Как цитировать
Plaksa, N. V. (2018). Трехлетний опыт лечения больных доброкачественной гиперплазией простаты: от открытой операции к биполярной энуклеации. Вопросы экологии, 8(4), 41–49. https://doi.org/10.25726/NM.2019.48.73.005
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