钬激光和电切除术在经尿道前列腺剜除术中应用的比较

Comparison of Holmium Laser and TURP in Transurethral Enucleation in BPH Patients

目的研究,比较钬激光和电切术在经尿道前列腺剜除术中的有效性和安全性。方法将87例前列腺增生患者分为2组,分别采用钬激光（Ho）组或电切组（Turp）经尿道前列腺剜除术,比较2组患者手术前后IPSS评分,残余尿量,最大尿流率,手术失血量及电解质等指标变化。结果 2组患者年龄,前列腺体积,术前IPSS评分,残余尿量,最大尿流率等指标均无统计学差异（P均〉0.05）。Ho组手术时间38～112min,平均65.6±10.3min,出血量90～560ml,平均235±15.5ml,无输血。术后留置导尿管平均3.6d。Turp组手术时间30～110min,平均58.55±8.6min,出血量120～760ml,平均345±20.5ml,无输血。术后留置导尿管平均4.0d。Turp组手术时间较Ho租短,而失血量大于Ho组,但并无统计学差异。2组患者手术前后血红蛋白,血电解质浓度,渗透压等均无明显差异,无电切综合征。2组患者术前IPSS评分,残余尿量,最大尿流率等指标与3个月后的指标相比,均存在统计学差异（P〈0.05）。各指标同期对比均无统计学差异（P〉0.05）。结论钬激光或电切术经尿道前列腺剜除术均可有效治疗前列腺增生症缓解下尿路梗阻症状,其近期疗效相当。术中钬激光止血效果确切,但解剖清晰度逊于电切术。

Objective To investigate and compare the effect and safety of Holmium laser and TURP in transurethral enucleation in BPH patients. Methods Eighty-seven BPH patients were divided into 2 groups and underwent transurethral enucleation of the prostate with holmium laser （Ho group） and TURP （Turp group）.respectively.Comparisons were made between the 2 groups in operation time, bleeding volume,electrolyte,IPSS score,PVR and Qmax. Results No statistically significant differences were noted between the 2 groups in age and preoperative prostate volume , IPSS,PVR and Qmax（P〉0.05）.The mean operation time was shorter in the TURP group {30-110 min},than in HO troup {38---112 min};blood loss was less in the former {120 760 ml}than in the latter {90---560ml},with no blood transfusion necessitated ;and the mean times of catheter indwelling were 2.4 d and 2.5 d respectively .There were no significant differences in the levels of hemoglobin and electrolyte before and after operation between the twogroups,and no TURP syndrome was observed.IPSS,PVR and Qmax before operation were significantly different from those obtained 3 months after it（P〈0.05） in both the groups,but none of the indexes exhibited statistically significant differences when compared in the same period （P〉0.05）. Conclusion Both holmium laser and TURP transurethral enucleation of the prostate can alleviae LUTS in BPH patients with similar short-time effectiveness. Holmium laser is superior to TURP in hemostasis,but inferior to it in anatomical distinctness.