1470 nm半导体激光前列腺剜除术与电切术治疗大体积前列腺增生疗效比较

Comparative study of the safety and efficacy between 1470nm laserenucleation of the prostate and transurethral resection of the prostate forbenign prostatic hyperplasia with over 80 mL volume

目的:比较1470 nm半导体激光前列腺剜除术(LEP)与经尿道前列腺电切术(TURP)治疗大体积(≥80 mL)良性前列腺增生(BPH)患者的疗效和安全性。方法:回顾性分析2017年8月-2019年2月中国人民解放军中部战区总医院泌尿外科收治的90例大体积BPH患者资料,45例行LEP治疗,45例行TURP治疗。记录两组患者手术时间、腺体切除重量、血红蛋白下降值、血清Na+下降值、膀胱持续冲洗时间、术后留置导尿管时间、平均住院时间及术后并发症等。评估术前及术后3个月国际前列腺症状评分(IPSS)、生活质量评分(QOL)、剩余尿量(PVR)及最大尿流率(Qmax)等情况。结果:LEP组与TURP组的手术时间[(75.4±16.3)与(96.2±17.4)min]、腺体切除重量[(62.4±14.5)与(46.5±13.6)g]、血红蛋白下降值[(1.5±0.4)与(4.6±1.2)g/L]、血清Na+下降值[(1.8±0.5)与(4.3±1.2)mmol/L]、膀胱冲洗时间[(1.5±0.4)与(2.5±0.3)d]、留置导尿管时间[(2.4±0.5)与(4.6±1.2)d]、平均住院时间[(5.4±1.4)与(7.6±1.5)d]比较均差异有统计学意义(P<0.05)。术后3个月随访,两组IPSS评分、QOL评分、PVR及Qmax均较术前显著改善(P<0.05),但两组间差异无统计学意义(P>0.05)。TURP组2例术后予以输血治疗,1例发生电切综合征(TURS),4例短暂性尿失禁,1例尿道狭窄;LEP组无输血、TURS和尿道狭窄病例,2例短暂性尿失禁,LEP组术后并发症发生率低于TURP组[4.4%(2/45)和17.8%(8/45)],差异有统计学意义(χ~2=0.050,P=0.044)。结论:LEP和TURP治疗大体积BPH疗效相当,但LEP相比TURP具有手术时间短、出血风险少、恢复快、并发症发生率较低等优势。

Objective:To compare the safety and efficacy of the two surgical approaches,1470 nm laser enucle⁃ation of the prostate(LEP)versus transurethral resection of the prostate(TURP),in the treatment of benign prostat⁃ic hyperplasia with over 80 mL volume.Methods:From August 2017 to February 2019,90 cases of BPH with over 80 mL volume were enrolled,including 45 cases undergoing LEP,and 45 cases receiving TURP.The operative time,the weight of resected gland,drop in hemoglobin and sodium ion,duration of postoperative bladder irrigation,indwelling catheterization time,hospital stay and the postoperative complications were recorded.IPSS,QOL,PVR and Qmax were also compared.Results:Patients in the LEP group displayed shorter operative time[(75.4±16.3)min vs.(96.2±17.4)min],lower risk of haemorrhage[(1.5±0.4)g/L vs.(4.6±1.2)g/L],lower sodium ion de⁃crease[(1.8±0.5)g/min vs.(4.3±1.2)g/min],shorter bladder irrigation time[(1.5±0.4)d vs.(2.5±0.3)d]and shorter catheter indwelling time[(2.4±0.5)d vs.(4.6±1.2)d],as well as shorter hospital stays[(5.4±1.4)d vs.(7.6±1.5)d](P<0.05).The IPSS,QOL,PVR and Qmax were significantly improved after 3 months postopera⁃tively in both groups,but there were no significant differences between the two groups(P>0.05).Two cases re⁃quired blood transfusion in the TURP group after operation,and none in the LEP group.TURS occurred in one case of the TURP group,and none in the LEP group.The incontinence presented in both groups(4 in the TURP group and 2 in the LEP group).Re-operations due to the urethral stricture and bladder neck contracture were needed in 1 case of the TURP group,and none in the LEP group.Conclusions:LEP is an excellent treatment for BPH with over 80 mL volume as well as TURP.However,compared with TURP,LEP has the advantages of shorter operative time,less risk of bleeding,rapid recovery,and lower incidence of complications.