低功率钬激光前列腺剜除术治疗良性前列腺增生症的疗效分析

Clinical Effectiveness of Low Power Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

目的:评价低功率(48 W、36 W)钬激光前列腺剜除术(LPHoLEP)治疗良性前列腺增生症(BPH)的临床效果。方法:入选三六三医院泌尿外科2017年8月-2019年8月收治的需手术治疗的BPH患者268例,采用随机数字法分为研究组和对照组,每组134例,研究组采用LPHoLEP(48 W、36 W)进行手术,对照组采用B-TURP进行手术。比较两组手术时间、标本重量、术后血清Na^(+)、术后血Hb、术后冲洗时间、留置尿管时间、住院时间、并发症发生率、术后1个月Q_(max)、IPSS、QOL以及PSA。另外,研究组70例分为A组,行48 W LP-HoLEP术,64例分为B组,行36 W LP-HoLEP术,比较A、B两组的手术时间、剜除效率、粉碎效率、标本重量、术后血Hb以及并发症发生率。结果:研究组手术时间[(83.6±17.2)vs.(95.8±14.6)min,t=14.089,P=0.016]、标本重量[(59.7±12.1)vs.(42.6±11.3)g,t=16.416,P=0.012]、术后血清Na^(+)[(142.3±4.7)vs.(131.4±3.1)mmol/L,t=11.368,P=0.018]、术后血Hb[(116.8±6.1)vs(101.6±7.4)g/L,t=19.573,P=0.007]、术后冲洗时间[(0.8±0.4)vs.(1.5±0.3)d,t=2.023,P=0.037]、留置尿管时间[(2.1±1.2)vs.(4.5±1.7)d,t=6.875,P=0.024]、住院时间[(3.8±1.6)vs.(6.7±2.1)d,t=7.316,P=0.021]、并发症发生率[38(28.4%)vs.58(43.3%),χ^(2)=10.821,P=0.019]与对照组相比较,差异有统计学意义(P<0.05);研究组术后Q_(max)、IPSS、QOL、PSA与对照组相比较,差异无统计学意义(P>0.05)。A组手术时间、剜除效率、粉碎效率、标本重量、术后血Hb、并发症发生率与B组相比较,差异无统计学意义(P>0.05)。结论:LPHoLEP(48 W、36 W)治疗BPH安全、有效,与TURP相当,其并发症发生率低,且使用低功率钬激光可以降低医疗成本,值得临床推广。

Objective:To investigate the clinical effectiveness of low power holmium laser enucleation of the prostate(LP-HoLEP)for benign prostatic hyperplasia(BPH).Methods:Totally,268 patients during August 2017 to August 2019 were randomized into experimental group and control group(n=134 each).The experimental group received LP-HoLEP,and the control group received bi-polar transurethral resection of prostate(B-TURP).The operation time,the weight of the specimens,postoperative serum Na^(+),postoperative blood Hb,the bladder irrigation time,the indwelling catheter time,the hospitalization days,the incidence of postoperative complications,postoperative Q_(max),IPSS,QOL and PSA at 1-month follow-up were compared between the two groups.Subgroup analysis was carried out in experimental group:70 patients undergoing 48-W LP-HoLEP(subgroup A),and the rest 64 patients given 36-W LP-HoLEP(subgroup B).The operation time,the enucleation efficiency,the morcellation efficiency,the weight of the specimens,postoperative blood Hb and the incidence of postoperative complications were compared between the two subgroups.Results:The operation time[(83.6±17.2)vs.(95.8±14.6)min,t=14.089,P=0.016],the weight of the specimens[(59.7±12.1)vs.(42.6±11.3)g,t=16.416,P=0.012],postoperative serum Na^(+)[(142.3±4.7)vs.(131.4±3.1)mmol/L,t=11.368,P=0.018].postoperative blood Hb[(116.8±6.1)vs.(101.6±7.4)g/L,t=19.573,P=0.007],the bladder irrigation time[(0.8±0.4)vs.(1.5±0.3)d,t=2.023,P=0.037],the indwelling catheter time[(2.1±1.2)vs.(4.5±1.7)d,t=6.875,P=0.024],the hospitalization days[(3.8±1.6)vs.(6.7±2.1)d,t=7.316,P=0.021]and the incidence of postoperative complications[38(28.4%)vs.58(43.3%),χ^(2)=10.821,P=0.019]between the two groups were statistically significant(P<0.05).The postoperative Q_(max),IPSS,QOL and PSA at 1-month follow-up between the two groups showed no statistically significant differences(P>0.05).In subgroup analysis,the operation time,the enucleation efficiency,the morcellation efficiency,the weight of the specimens,postoperative blood Hb and the incidence of postoperative complications between subgroup A and subgroup B showed no significant difference(P>0.05).Conclusion:LP-HoLEP(48 W,36 W)which had low incidence of postoperative complications had similar safety and efficacy to TURP,meanwhile,it could reduce medical cost,so it was worthy of clinical application.