比較雙極電刀及單極電刀在治療良性攝護腺增生的內視鏡刮除手術其效能與安全性－－初步報告

Comparison of Bipolar Electrocautery Device and Traditional Monopolar Electrocautery Device in TURP for the Treatment of Benign Prostatic Hyperplasia--Preliminary Peport

比較雙極電刀及單極電刀在治療良性攝護腺增生的內視鏡刮除手術其效能與安全性－初步報告。傳統單極電刀在從事經尿道攝護腺刮除手術的最大併發症即是手術中蒸餾水吸收造成水中毒。雙極電刀以生理食鹽水做為術中的沖洗液、因而減少經尿道刮除手術症候群的發生。本文旨在比較比較雙極電刀及單極電刀在治療良性攝護腺增生的內視鏡刮除手術其效能與安全性。從2003年4月至10月、總共收集40位良性攝護腺增生的病患以隨機的方式接受雙極電刀（22位）及單極電刀（18位）的治療、分析兩組的手術時間、刮除的病理重量、流血量、術前及術後的血紅素和鈉離子變化與術後6個月及1年的I-PSS、Qmax和國際勃起功能指數（IIEF-5）的比較。兩組在手術時間、刮除的病理重量、流血量並沒有統計學上的差異、術後I-PSS及Qmax的比較上、兩組都有相同的改善結果。但在手術後血清鈉離子的變化，單極電刀比雙極電刀這一組有明顯的降低（P＜0.001）。雙極電刀和單極電刀在治療良性攝護腺增生有相同的效果、但因雙極電刀可降低經尿道刮除手術症候群的發生、所以較單極電刀安全。

The major complication of traditional monopolar TURP is water intoxication due to distilled water absorption during resection. The new bipolar electrocautery device can be used in TURP procedure using saline irrigation and therefore decrease TUR syndrome. The aim of this study is to evaluate the efficacy and the safety of this new system in TURP. From April to October 2003, totally 40 patients aged 58 to 86 years (means: 69.3) were randomly assigned to receive bipolar or monopolar TURP. Pre-operative and post-operative serum sodium concentration, hemoglobin level, resection time, blood loss and weight of specimen were checked. Qmax, I-PSS, IIEF-5 and bladder neck contracture were reassessed at the 6-month and 1-year visits. Results: There were no significant differences in hemoglobin level, blood loss, resection time and weight of specimen between two groups. The difference of serum sodium level change after the operation was significant between these 2 groups (P < 0.001). Bipolar electrocautery device is safer than traditional monopolar electrocautery device for TURP procedure by decreasing of TUR syndrome and produces the similar results at 6 months and 1 year of follow-up.