经尿道选择性绿激光前列腺汽化术与前列腺电切术治疗重度良性前列腺增生的对比研究

Comparative study on efficacy of greenlight photoselective vaporization of prostate and transur ethral resection of prostate for treatment of enlarged benign prostatic hyperplasia

目的比较经尿道选择性绿激光前列腺汽化术与前列腺电切术治疗重度良性前列腺增生症的临床疗效。方法将63例重度良性前列腺增生症患者随机分为经尿道选择性绿激光前列腺汽化术(PVP)组32例和前列腺电切术(TURP)组31例,分别行PVP术与TURP术。观察两组患者手术时间、住院时间、保留导尿管时间、手术出血量、IPSS评分、最大尿流率、前列腺体积的变化及并发症。结果所有手术均成功,无严重手术并发症发生。TURP组电切综合征、输血病例各2例,PVP组无该并发症。PVP组手术出血量、输血率、住院时间及留置导尿管时间明显少于TURP组(P>0.05),然而,PVP组的手术时间、术后感染控制时间、早期急性尿潴留发生率及残留腺体体积明显大于TURP组。两组术后IPSS评分下降率、最大尿流率差异、感染发生率及逆行射精发生率差别均无显著性(P>0.05)。结论治疗重度良性前列腺增生时,PVP手术具有一定的局限性,可作为TURP的一种补充手术方法应用于高危患者的治疗,而不作重度良性前列腺增生的首选治疗方法。

Objective To comparatively analyze the efficacy of greenlight photoselective vaporization of prostate （PVP） and transuretharal resection of prostate （TURP） for treatment of enlarged benign prostatic hyperplasia. Methods Sixty-three consecutive patients with enlarged benign prostatic hyperplasia were randomly divided into groupl（n =32） treated with PVP and group2 （n= 31） treated with TURP. Operative data, hospitalization periods, blood loss, catheter removal, international prostate symptom score （IPSS）, maximum flow rates （Qmax）, transrectal ultrasound （TRUS） volumes and complications of the treated patients were recorded. Results Baseline characteristics of both groups were similar. Two patients treated by TURP received a blood transfusion. The time of catheter removal and hospital stay were significantly longer and the risk of blood transfusion was higher in group2 than that of groupl. However, the operation time and the time of infection control were significantly longer, the rate of acute urinary retention and the percentage volume residual were significantly higher in groupl than that of group2. No significant differences were found in IPSS, Q and the incidence of urethral strictures （P〉0.05）. Conelution Our results suggested that transuretharal resection of prostate （TURP） should be recommendated as first choice for treatment of enlarged benign prostatic hyperplasia, and greenlight photoselective vaporization of prostate（PVP） was used as a supplement therapy.