前列腺钬激光剜出术与电切术安全性及疗效比较

A comparative study of the efficacy and safety of holmium laser enucleation of the prostate vs transurethral resection of the prostate

目的 比较研究经尿道钬激光前列腺剜除术 (HoLEP)与经尿道前列腺电切术 (TURP)的安全性及疗效。 方法 337例良性前列腺增生 (BPH)患者分为 2组 ,185例行HoLEP术 ,15 2例行TURP术 ;测定术中冲洗液吸收量、出血量 ;比较 2组术中冲洗液吸收量、出血量、前列腺切除重量、手术时间、导尿管留置时间、术后住院天数、手术并发症。随访 3个月 ,比较 2组最大尿流率(Qmax)、剩余尿量 (PVR)、国际前列腺症状评分 (IPSS)、生活质量评分 (QOL)等指标的变化。 结果 HoLEP组、TURP组术中冲洗液吸收量、出血量、前列腺切除重量、手术时间、导尿管留置时间、术后住院天数分别为 (6 0 4 .8± 97.6 )ml及 (10 95 .0± 2 0 9.8)ml、(12 4 .3± 2 4 .1)ml及 (330 .3± 36 .9)ml、(17.4± 2 .2 )g及 (2 5 .2± 3.4 ) g、(5 4 .9± 2 0 .0 )min及 (4 5 .1± 18.0 )min、(2 .2± 0 .2 )d及 (3.4± 0 .3)d、(5 .2± 1.1)d及 (8.8± 1.3)d ,组间比较差异有显著性意义 (P <0 .0 5 )。HoLEP组术中 1.6 % (3/ 185 )需输血 ;TURP组 11.8% (18/ 15 2 )需输血。HoLEP组术后需要膀胱持续冲洗者占 6 .5 % (12 / 185 ) ,TURP组占 95 .4 % (14 5 / 15 2 )。TURP组有 5 5 .3% (84 / 15 2 )出现术后低血钠 ,其中 5 .3% (8/ 15 2 )发生严?

Objective To compare the safety and efficacy of holmium laser enucleation of the prostate (HoLEP), one of the minimally invasive treatments available for men with benign prostatic hyperplasia (BPH),with transurethral resection of the prostate (TURP). Methods A total of 337 cases of BPH were divided into 2 groups;of them 185 cases underwent HoLEP and 152,TURP.The volume of irrigating fluid absorption and blood loss,and other therapeutic results were measured and compared between the 2 groups. Results Comparison between HoLEP group and TURP group included the following:irrigating fluid absorption was (604.8±97.6)ml vs (1095.0±209.8)ml;blood loss,(124.3±24.1)ml vs (330.3±36.9)ml;resected prostate weight,(17.4±2.2)g vs (25.2±3.4)g;operating time,(54.9±20.0) min vs (45.1±18.0) min;catheterization time,(2.2±0.2) d vs (3.4±0.3)d;and length of hospital stay after operation, (5.2±1.1) d vs (8.8±1.3) d. Significant differences were found between the 2 groups (P<0.05). Intraoperative blood transfusion was needed in 1.6%(3/185)of HoLEP group vs 11.8% (18/152) of TURP group, and postoperative bladder irrigation in 6.5% (12/185) of HoLEP group vs 95.4% (145/152) of TURP group.55.3% (84/152) of TURP group developed hyponatremia,with 5.3% (8/152) of severe hyponatremia; while no hyponatremia occurred in HoLEP group.The pathology showed HoLEP group all had BPH.There were 6 cases of incidental prostatic carcinoma and 5 of prostatic intraepithelial neoplasia in TURP group. Of all the cases,172 of HoLEP and 106 of TURP were followed up for 3 months;Qmax,PVR,IPSS and QOL improved significantly compared with preoperation (P<0.01). No significant difference was found between the 2 groups. Conclusions HoLEP is superior to TURP in safety and as efficacious as TURP;however,less obtainment of surgical specimens with HoLEP may miss to detecting incidental prostatic carcinoma.