经尿道大功率绿激光汽化术与等离子前列腺电切术治疗良性前列腺增生症的比较

Comparison of High-power Potassium Titanyl Phosphate Laser Vaporization Prostatectomy and Transurethral Plasmakinetic Resection of Prostate in the Treatment of Benign Prostatic Hyperplasia

目的探讨经尿道大功率磷酸钛氧钾晶体激光（绿激光）治疗良性前列腺增生症（benign prostatic hyperplasia，BPH）的有效性和安全性。方法2010年4月～2012年1月将180例良性前列腺增生症按手术方式分为PVP组与TUPKRP组，每组各90例。比较2组手术时间、术中出血量、术后冲洗时间、术后导尿管留置时间、术后并发症发生率、拔管后24hQmax、术后3个月IPSS、QOL、Qmax等指标。结果PVP组手术时间（65±25）min，显著长于TUPKRP组（45±15）min（t=6．479，P=0．000）；PVP组术中出血量（103±36）ml，显著少于TUPKRP组（304±75）ml（t=-22．605，P=0．000）。PVP组留置导尿时间（16．2±8．2）h，显著短于TUPKRP组（144．3±7．8）h（t=106．513，P=0．000）；PVP组术后4例发生需要处理的膀胱痉挛，显著少于TUPKRP组12例[4．6％（4／87）VS．13．3％（12／90），x^2=4．106，P=0．043]；PVP组术后并发症发生率5．7％（5／87），显著低于TUPKRP组23．3％（21／90）（x^2=10．918，P=0．001）。PVP组拔管24h后Qmax（17．5±2．3）ml／s，TUPKRP组（17．9±2．5）ml，2组无显著性差异（t=-1．107，P=0．270）。术后3个月PVP组IPSS（10．8±4．8）分，与TUPKRP组（11．4±5．9）分无显著性差异（t=-0．731，P=0．466）；PVP组QOL评分（2．0±0．6）分，与TUPKRP组（2．1±0．5）分无显著性差异（t=-1．189，P=0．236）；PVP组Qmax（15．8±4．2）ml／s，与TUPKRP组（16．5±3．8）ml无显著性差异（t=-1．147，P=0．253）。结论PVP能达到与TUPKRP相同的治疗效果，但比TUPKRP并发症少，留置导尿管时间短。

Objective To study the efficacy and safety of transurethral high-power potassium titanyl phosphate laser vaporization prostatectomy （PVP） for the treatment of benign prostatic hyperplasia （BPH）. Methods A total of 180 patients underwent either PVP （PVP group） or transurethral plasmakinetie resection of prostate （TUPKRP group） , with 90 patients in each group. The operation time, blood loss, postoperative bladder irrigation time, postoperative catheterization time, postoperative complications, Qmax 24 h after extubation, IPSS, QOL and Qmax scores 3 months after the surgery were compared between the two groups. Results The operation time of PVP group was significantly longer than that of TUPKRP group [ （65 ± 25 ） min vs. （45 ± 15）min, t =6.479, P =0. 000]; blood loss of PVP group was significantly less than that of TUPKRP group [ （103 ± 36）ml vs. （304 ± 75 ） ml, t = - 22. 605, P = 0. 000） ] ; postoperative catheterization time of PVP group was significantly shorter than that of TUPKRP group [（16.2±8.2）h vs. （144.3 ±7.8）h, t =106.513,P=0.000]. Four patients in PVP group experienced bladder spasms, which required treatments, and the incidence was significantly less than that of TUPKRP group [4.6% （4/87） vs. 13.3% （12/90） , x^2 = 4. 106,P = 0. 043 ]. Postoperative complication was 5.7% （5/87）in PVP group, which was significantly less than that of TUPKRP group [ 23.3% （21/90）, x^2 = 10. 918, P = 0. 001 ]. No significant differences could be found between PVP group and TUPKRP group： Qmax24 h after extubation [（17.5 ±2.3）ml/s vs. （17.9 ±2.5）ml/s, t = -1.107,P=0.270]; IPSS 3 months after operation （ 10.8 ± 4.8 vs. 11.4 ± 5.9, t = - 0.731 ,P = 0. 466） ; QOL 3 months after operation [ （2.0 ± 0.6） points vs. （2.1 ± 0.5）points, t= -1.189,P=0.236] ; Qmax3 months after operation [（15.8 ±4.2）ml/svs. （16.5 ±3.8）ml/s, t= -1.147, P= 0. 253 ]. Conclusion PVP has the same curative effect as TUPKRP, with less complications and catheterization time.