经尿道钬激光剜除术治疗良性前列腺增生症

Transurethral holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia

目的探讨经尿道钬激光前列腺剜除术治疗良性前列腺增生症的疗效及其安全性。方法回顾性分析经尿道钬激光前列腺剜除术治疗68例良性前列腺增生症患者年龄65.7岁(50～91岁)的资料,并对其疗效、并发症的发生情况等进行评估。结果手术时间45～158 min,平均87min,切除的标本组织重量31～128 g,平均61 g。术中视野清晰,出血极少,均无输血;且整个手术经过平稳,无前列腺电切综合征和其他严重并发症发生。术后留置尿管1～4 d,平均2.8 d;术后住院2～5 d,平均3.6d。术后随访1～13个月,平均7.6个月,排尿梗阻症状明显改善,IPSS 由术前的25.7±6.9减至7.7±4.3(P<0.01),平均最大尿流率由术前的(8.1±4.2)ml/s 升至(18.8±4.6)ml/s(P<0.01)。2例术后发生暂时性尿失禁,经过括约肌功能锻炼,均于术后3个月内恢复。1例术后发生轻度后尿道狭窄,经尿道扩张后恢复。结论经尿道钬激光前列腺剜除术治疗良性前列腺增生症高效、微创、安全、并发症少、住院时间短,是治疗前列腺增生症的一种安全而有效的新方法。

Objective To evaluate the efficacy and safety of transurethral holmium laser enucleation of the prostate （HoLEP） for the treatment of benign prostatic hyperplasia （BPH）. Methods A retrospective review was conducted of transurethral （HoLEP） performed on 68 patients, aged 65.7 （ 50 - 91 ） with benign prostatic hyperplasia. The efficacy and complications were all assessed. Results The mean procedure time was 87 mins （45 - 158 mins）. The mean specimen weight was 61 g （31 - 128 g）. The procedure allows a precise, bloodless field with no need for transfusion. No TUR syndrome and other majoredcomplications were encountered during the operation. The mean catheter time and hospital stay were 2. 8 d （ 1 - 4 d） and 3.6 d （ 2 - 5 d）, respectively. Follow-up of 7.6 months （ 1 - 13 months） revaled that the urination symptoms were markedly improved in all patients, and that the IPSS decreased from 25.7 ± 6.9 to 7.7 ±4. 3 （P 〈0. 01 ） and the maximum urine flow rate increased from 8.1 ±4. 2 ml/s to 18.8 ±4. 6 ml/ s （ P 〈 0. 01 ）. Postoperative complications occurred in 3 patients. 2 with transient incontinence were recovered within 3 minths postoperatively. The other one with mild posterior urethral stricture was treated effectively with urethral sounding. Conclusions Was associated with high effectiveness, safety, short hospital stay and less complications, HoLEP is a new minimally invasive surgical procedure for BPH.