"三叶法"直出绿激光汽化剜切术治疗良性前列腺增生

Treatment of benign prostatic hyperplasia with three lobes based transurethral greenlight vaporization and enucleation of the prostate

目的:探讨"三叶法"经尿道直出绿激光汽化剜切术(TVEP)在良性前列腺增生(BPH)治疗中的有效性及安全性.方法:回顾分析2016年1月-2018年12月收治838例BPH患者资料,其中行"三叶法"TVEP治疗者623例,行经尿道前列腺切除术(TURP)者215例.两组患者的年龄、前列腺体积、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、剩余尿量(PVR)比较均差异无统计学意义(P>0.05).分别比较两组手术时间、手术前后血红蛋白及血清钠的变化、术后膀胱冲洗时间、留置尿管时间、术后住院时间等指标,以及术中、术后手术并发症发生率、术前和术后3个月的IPSS评分、QOL、Qmax、PVR等变化.结果:两组手术均顺利完成.TVEP组与TURP组的手术时间比较差异无统计学意义(P>0.05),TVEP组手术前后血红蛋白减少量、血清钠减少量、术后膀胱冲洗时间、术后留置尿管时间、术后住院时间、术中和术后总体并发症发生率均明显低于TURP组,两组比较均差异有统计学意义(P<0.05).术后3个月,两组IPSS、QOL、Qmax和PVR比较均差异无统计学意义(P>0.05),但是,两组数据均较术前明显改善(P<0.05).结论:采用"三叶法"直出绿激光汽化剜切术治疗BPH,技术操作简捷易控,可最大程度地切除增生的前列腺组织,具有疗效好、出血少、安全性高、风险低、恢复快等优点,值得推广.

Objective:To evaluate the clinical efficacy and safety of three lobes based transurethral greenlight vaporization and enucleation of the prostate(TVEP)for the treatment of benign prostatic hyperplasia(BPH).Methods:A retrospective analysis was performed on 838 patients with BPH who underwent three lobes based TVEP(n=623)or transurethral resection of the prostate(TURP,n=215).Between the two groups,there was no significant difference in preoperative clinical data,including the average age,prostate weight,international prostate symptom score(IPSS),quality of life score(QOL),maximum urinary flow rate(Qmax),and postvoid residual urine(PVR)(P>0.05).The mean operative time,changes of hemoglobin and serum sodium before and after the operation,postoperative bladder irrigation,catheter indwelling duration,and hospital stay were recorded.In addition,the complications,pre-and 3 months post-operative IPSS,QOL,Qmax,and PVR were monitored.Results:The operation was completed successfully in both groups.In the TVEP group,patients received three lobes based TVEP in the middle and bilateral leaves of the prostate respectively.There was no significant difference in the mean operation time between the two groups(P>0.05).The changes of hemoglobin and serum sodium before and after the operation,postoperative bladder irrigation duration,catheter indwelling duration,hospital stay,and complication rate in the TVEP group were significantly reduced as compared with those in the TURP group(P<0.05).There was significant improvement of IPSS,QOL,Qmax,and PVR in the two groups at 3rd month after surgery,while no significant difference was found between the two groups(P>0.05).Conclusions:Three lobes based TVEP,which is simple and easy,is safe and effective for the treatment of BPH with a maximum excision of the hyperplastic prostate tissue.It is a minimally invasive surgery with better efficacy,less intraoperative bleeding,higher security,lower risk,and quicker recovery for the patients,which deserves to be popularized.