铥激光与等离子前列腺切除术疗效的比较研究

A comparative study of thulium laser resection of the prostate and bipolar transurethral plasmakinetic prostatectomy for the treatment of benign prostatic hyperplasia

目的 比较经尿道铥激光前列腺切除术（thulium laser resection of the prostate,TMLRP）与经尿道等离子前列腺电切术（bipolar transurethral plasmakinetic prostatectomy,TUPKP）的安全性和近期疗效. 方法 2009年11月至2010年8月100例BPH患者根据随机表随机分为2组,每组50例.2组患者年龄、国际前列腺症状评分（IPSS）、前列腺体积、前列腺特异性抗原、最大尿流率（Qmax）、残余尿（PVR）比较差异无统计学意义（P＞0.05）.2组分别行TMLRP和TUPKP手术,比较2组患者手术前后电解质、手术时间、术后膀胱持续冲洗时间、留置导尿时间、术后住院天数、手术并发症及术后3个月Qmmax、PVR、IPSS、生活质量评分（QOL）等指标. 结果 TMLRP组和TUPKP组手术时间分别为（61.2±24.2）、（30.1±15.9） min,留置导尿时间（1.8±0.4）、（3.2±0.6）d,术后住院天数分别为（3.3±0.8）、（4.1±1.3）d,2组间比较差异有统计学意义（P＜0.05）.TMLRP组术中出血极少,术后膀胱冲洗3例,无低钠血症发生.TUPKP组手术前后血红蛋白发生明显变化者4例,但无输血；术后均行膀胱冲洗,冲洗时间（2.7±0.7）d,无低钠血症；术后1个月发生尿道狭窄4例.术后3个月,2组患者IPSS、QOL、QmaxPVR与术前比较差异均有统计学意义（P＜0.01）,组间比较差异无统计学意义（P＞0.05）. 结论 与TURP相比,TMLRP治疗BPH切割精准、出血少、恢复快、并发症少、安全性高,近期疗效和TUPKP相近.

Objective To compare the safety and short-term efficacy of thulium laser resection of the prostate （ TMLRP ） and bipolar transurethral plasmakinetic prostatectomy （ TUPKP ） for the treatment of benign prostatic hyperplasia （BPH） patients. Methods A total of 100 patients diagnosed with BPH were randomly divided into 2 groups： TMLRP group （50 cases） and TUPKP group （50 cases）. There was no sig- nificant difference of preoperative variables such as age, prostate volume, PSA, IPSS, Qmax and PVR between the two groups （P〉 0.05）. The perioperative parameters and therapeutic effects were recorded and compared between the two groups. Results Comparison between TMLRP group and TUPKP group includ- ed： operating time （（51.2±24.2） rain versus （30.1±15.9） rain）, catheterization time （（1.8±0.4） d ver- sus （3.2±0.6） d） and postoperative hospital stay （（3.3±0.8） d versus （4.1±1.3） d）. Significant differ- ences in these parameters were found between the two groups（P〈0.05）. Compared with TUPKP group, the blood loss and postoperative bladder irrigation were significantly less in TMLRP group. One month postopera- tively, there were 4 cases of urethral stricture in TUPKP group. Three months postoperatively, IPSS, QOL, Qmax and PVR were significantly improved in both groups （P〈0.01） , hut no significant difference detected between the 2 groups （P〈0.05）. Conclusions TMLRP is superior to TUPKP in term of safety and tolera- bility （decreased blood loss, complication rate and short recovery time） , and as efficacious as TUPKP in ef- ficacy. Compared with TUPKP, operating time were significantly longer in TMLRP group .