经尿道钬激光前列腺剜除术治疗前列腺增生

Transurethral holmium laser enucleation of the prostate

目的评价经尿道钬激光前列腺剜除和前列腺组织粉碎术治疗良性前列腺增生(BPH)的临床效果,探讨手术操作技巧及并发症的预防。方法应用100 W钬激光器和组织粉碎器对45例BPH患者实施经尿道钬激光前列腺剜除(HoLEP)和组织粉碎术。术前国际前列腺症状评分(IPSS)为15-32分,平均24.0分,最大尿流率(Qmax)为4-15 mL/s,平均8.4 mL/s,膀胱残余尿为60-246 mL,平均115 mL。结果41例行HoLEP手术成功。手术时间50-200 min,平均105 min,获得前列腺组织30-85 g,平均48.6 g,其中输血5例,膀胱黏膜或膀胱壁损伤5例,尿失禁1例,尿道狭窄3例。保留导尿时间3-7 d,平均4.3 d。术后35例获随访3个月,IPSS降至3-10分,平均5.2分(P<0.01),Qmax升至18-25 mL/s,平均22.4 mL/s(P<0.01),膀胱残余尿为0-68 mL,平均26 mL(P<0.01)。结论经尿道钬激光剜除前列腺组织损伤小,术中出血少,并发症少,疗效可靠。HoLEP学习曲线较长,应注意手术技巧的掌握,减少并发症的发生。

Objective To evaluate the clinical effect of the holmium laser enucleation and morcellation of prostate （HoLEP） in the treatment of benign prostatic hyperplasia （BPH）, and to discuss the skills in the operative procedure and the prevention of complications. Methods In the treatment of 45 BPH patients, 100 watt high-powered holmium laser set was used transurethrally and a tissue morcellator was introduced via a nephroscope to enucleate and morcellate the prostatic tissue. Results 41 cases were operated successfully. The mean enucleation time was 105 min （ranging 50- 200 min）, and the enucleation tissue weight was 48.6 g （ranging 30-85 g）. 5 cases required blood transfusion; bladder injury was noted in 5 cases; incontinence developed in 1 case; and urethral stricture developed in 3 cases. The mean catheterization time was 4.3 d （ranging 3-7 d）. In the 3 months of follow-up of 35 cases, mean IPSS improved from 24.0 （ranging 15-32） to 5.2 （ranging 3-10） （P〈0.01）, mean peak urinary flow rate （Qmax） increased from 8.4 mL/s （ranging 4- 15 mL/s） to 22.4 mL/s （ranging 18-25 mL/s, P〈0.01）, and mean postvoid residual urine （PVR） decreased from 115 mL （ranging 60-246 mL） to 26 mL （ranging 0-68 mL） （P〈0.01）. Conclusion HoLEP is a safe and effective procedure with little blood loss and fewer complications for treatment of BPH. HoLEP requires longer training time, and we should improve our technique in the operative procedure.