绿激光前列腺汽化术对患者血管内皮功能影响及其围手术期安全性评价

Effect of green-light photoselective vaporization on vascular endothelial function of patients with benign prostatic hyperplasia and its safety during perioperative period

目的:探讨高龄前列腺增生症(BPH)患者不同术式与术后心血管意外的关系,评估经尿道绿激光前列腺汽化术(PVP)对高危前列腺增生患者的安全性.方法:72例接受手术治疗的BPH患者,其中开放手术(OP)组34例,PVP组38例;分别检测患者手术前后血清内皮素(ET-1)的动态变化,并按有或无冠心病(CHD)分层比较.结果:合并有CHD的BPH患者血清ET-1水平比较:术前OP组与PVP组无统计学差异(t=0.777,P>0.05),术后1d,OP组较PVP组升高(t=2.823,P<0.01);术后2d,两组比较,仍有统计学差异(t=4.678,P<0.01);无CHD的BPH患者,术前OP组与PVP组无统计学差异(t=0.478,P>0.05),术后1d,OP组较PVP组升高(t=4.370,P<0.01);术后2d,两组比较,仍有统计学差异(t=2.614,P<0.05).结论:BPH患者手术后存在着血管内皮功能障碍,而血管内皮功能受损可能是术后发生心血管不良事件的原因之一,尤以合并CHD的高危患者为甚,PVP是较安全的一种前列腺手术方法,可能减少合并CHD的高危前列腺增生患者术后心血管不良事件的发生.

AIM： To investigate the relationship between greenlight photoselective vaporization （PVP） and the stroke of coronary heart disease （CHD） and access the safety of PVP for benign prostatic hyperplasia （BPH） combined with CHD during perioperalive period. METHODS： Seventy-two patients underwent surgical treatment： open-operation （ n = 34 ）, PVP （ n = 38 ）. All 72 patients were divided into 2 groups according to whether BPH was combined with CHD or not （CHD group and non-CHD group）. The serum level of ET-1 was measured by ELISA before and after treatment,respectively. RESULTS： The levels of ET-1 in CHD groups[ OP group vs PVP group： （ 83.19 ± 12.83 ） vs （85.98 ± 10. 19） ng/L] before operation showed no significant difference（ t = 0. 777, P 〉 0. 05 ） ; One day after operation, the level of serum ET-1 Of OP group[ （123.01 ±25.98） ng/L] was significantly higher than that of PVP group [ （92.74 ± 10.40 ） ng/ L] （t = 2. 823, P 〈 0.01 ）, and 2d after operation, the level of serum ET-1 of OP group[ （114.1 ±28.22） ng/L] was still significantly higher than that of PVP group[ （90. 12 ± 10.22） ng/L] （t =4. 678, P 〈 0. 01 ）. The levels of ET-1 of non-CHD group [OP group vs PVP groups： （49.74 ±9.23） vs （48.10 ±9.10） ng/L] before operation showed no significant difference （t = 0.478,P〉0.05） ; ld after operation, the level of serum ET-1 of OP group[ （68.67 ± 12.55） ng/L] was significantly higher than that of PVP group [ （53.89 ±9.70） ng/L] （t =4. 370, P 〈 0.01）, and 2 d after operation, the level of serum ET-1 of OP group[ （114. 1 ±28.22） ng/L] was still significantly higher than that of PVP group[（90. 12 ±10.22） ng/L] （t =2.614,P〈 0.05）. CONCLUSION： There is a significantly damaged vascular endothelial function after OP in BPH patients, especially in BPH patients complicated with CHD. PVP is a kind of safe operation to BPH patients, especially those combined with CHD.