钬激光前列腺剜除术学习体会总结及手术效果评价

Evaluation of holmium laser enucleation of prostate in the treatment of BPH and summary on learning experience

目的:评价经尿道钬激光前列腺剜除术(holmium laser enucleation of prostate,HoLEP)手术效果,总结经验。方法:回顾性分析2015年1~7月我院最初开展HoLEP的连续40例良性前列腺增生(BHP)患者的临床资料。收集信息包括患者资料、手术资料,并进行3个月后的随访,并对收集到的数据进行总结和统计。结果:纳入研究的连续40例BPH患者,平均年龄(70.6±9.5)岁,按照手术先后时间分为A、B、C、D四组,每组各10例。四组患者的平均年龄、术前评估的前列腺重量及术中剜除的组织重量比较差异均无统计学意义。从A组到D组患者的平均手术时间逐渐减少,差异有统计学意义(包括剜除时间的逐渐减少,P=0.04;粉碎时间的逐渐减少,P=0.03)。四组术后的平均导管留置时间和平均住院时间比较差异无统计学意义(P>0.05)。另外,随着手术经验的增加,A组到D组的前列腺组织的剜除效率及粉碎效率都逐渐增加(P<0.05)。四组患者术前的最大尿流率(Qmax)、剩余尿量(PVR)、国际前列腺症状评分(IPSS)及生活质量评分(QOL)与术后3个月比较差异均无统计学意义(P<0.05)。结论:虽然HoLEP学习曲线较长,但是其手术效果好、术中术后出血少、手术安全性高。随着手术熟练程度的增加,术后并发症有减少的趋势。因此,HoLEP在BPH的治疗中是值得临床推广的一项技术。

Objective:To evaluate the effect of HoLEP in the treatment of BPH and summarize learning experience.Method:We retrospectively analyzed the clinical data of 40 consecutive BHP patients who initially performed HoLEP surgery in our hospital from January to July 2015.All patients were evaluated preoperatively and at an interval of 3 months postoperatively.Result:We separated the patients into four groups according to the order of surgery time(A to D,10 consecutive patients/group).The average age of four groups of patients,preoperative evaluation of prostate weight or enucleation tissue weight showed no statistical significance.Four groups were gradually reduced in terms of operative time(enucleation time P=0.04,morcellation time P=0.03).No statistical difference was found in hospital stay or catheterization duration in this study among four groups(all P>0.05).In addition,efficiency of tissue enucleation increased significantly as experience increased(P<0.05).On the other hand,Qmax,PVR,IPSS score or QOL index 3 months postoperatively did not change significantly compared with the preoperative data.Conclusion:HoLEP is a safe and highly effective technique for the surgical treatment of BPH,but it cannot be considered as an easy technique to learn and requires a long learning curve.With the increase of surgical proficiency,postoperative complications gradually decreased.Therefore,HoLEP in the treatment of BPH is worthy of popularizing.