经尿道选择性绿激光和电切同期治疗浅表性膀胱肿瘤合并良性前列腺增生的疗效比较

Comparison of efficacy on simultaneous treatment of benign prostate hyperplasia and superficial bladder tumor with photoselective vaporization and transurethral resection

目的评价经尿道选择性绿激光汽化术和电切术两种手术方法同期治疗浅表性膀胱肿瘤(SBT)合并良性前列腺增生(BPH)的疗效及安全性。方法对42例确诊的SBT合并BPH患者,随机分为激光组和电切组,分别应用经尿道选择性绿激光汽化术和电切术同期治疗膀胱肿瘤和前列腺增生。术后均辅以化疗药物膀胱内灌注。对国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、术中出血量、留置尿管时间、肿瘤复发情况及手术并发症(前列腺包膜及膀胱穿孔、闭孔神经反射、电切综合证)等指标进行比较。结果两组肿瘤均一次手术成功,3个月后IPSS、QOL及Qmax均较术前有显著差异(P<0.05)。激光组术中出血量、留置尿管时间以及手术并发症与电切组比较差异有统计学意义(P<0.05),两组治疗后在IPSS、QOL、Qmax及肿瘤复发情况方面比较差异无统计学意义(P>0.05)。结论选择性绿激光和电切都是治疗SBT合并BPH的有效方法,但绿激光在术后恢复及安全性方面优于电切。

Objective To evaluate the efficacy and safety on the treatment of superficial bladder tumor（SBT） and benign prostate hyperplasia（BPH） with photoselective vaporization and transurethral resection. Methods 42 patients diagnosed as SBT combined with BPH, were randomly divided into two groups, 21 patients were treated by photoselective vaporization, the other 21 patients were treated by transurethral blad- der tumour resection（TURBt） and transurethral resection of the prostate（TURP）. All patients were treated by intravesical chemotherapy after operation. The IPSS, QOL, Qmax, blood loss, duration of catheter, tumor recurrence and complication of operation（perforation, obturator reflex, transurethral resection syndrome） of the two groups were compared. Results All bladder tumor were resected successively. On three-month follow- up,IPSS,QOL and Qmax were significantly different between the two groups（P〈0.05）. In blood loss, duration of catheter placement, complication of operation were significantly different between the two groups（P〈O.05）. After operation, there was no significant difference between the two groups in IPSS, QOL, Qmax and tumor recurrent respectively （P〉0.05）. Condusions The two kinds of operations are efficient and safe for the simuhaneous treatment of SBT and BPH, but the photoselective vaporization is better than transurethral resection in postoperative recovery and security.