抗凝替代治疗在经尿道前列腺绿激光汽化术中的应用价值分析

The Value of Replacement Anticoagulation Therapy in Transurethral Vaporization of the Prostate Using KTP Laser for Benign Prostatic Hyperplasia

目的探讨抗凝替代治疗在经尿道前列腺绿激光汽化术中的安全性和有效性。方法选择2003年9月—2012年6月在海军总医院泌尿外科因心脑血管疾病术前长期服用抗凝药物且不可停止服药的良性前列腺增生(BPH)患者103例,均接受经尿道前列腺绿激光汽化术。根据是否接受抗凝替代治疗将患者分为替代治疗组55例,非替代治疗组48例,对两组的手术指标(手术时间、是否输血、尿管留置时间、术后住院时间)及疗效〔手术前后最大尿流率、国际前列腺症状评分(IPSS)〕进行对比分析。结果替代治疗组和非替代治疗组手术时间分别为(63.1±35.2)、(59.6±41.3)min,术后尿管留置时间分别为(5.2±2.3)、(5.3±2.4)d,术后住院时间分别为(8.4±5.3)、(8.0±6.1)d,差异均无统计学意义(t=0.46、0.35、0.35,P>0.05)。两组患者术中、术后均无一例需要输血,均在术后继续规律服用非那雄胺片3个月。替代治疗组和非替代治疗组术后1个月最大尿流率分别为(15.4±3.6)、(15.0±4.5)ml/s,差异无统计学意义(t=0.53,P>0.05),但较各自术前最大尿流率〔替代治疗组(8.3±3.7)ml/s、非替代治疗组(7.7±3.2)ml/s〕有明显改善,差异有统计学意义(P<0.05)。替代治疗组术后1个月IPSS为(10.2±3.9)分,非替代治疗组为(9.9±5.2)分,差异无统计学意义(P>0.05),但较各自术前IPSS〔替代治疗组(27.4±2.8)分、非替代治疗组(26.5±2.3)分〕有明显改善,差异有统计学意义(P<0.05)。结论采用经尿道选择性绿激光汽化术治疗无法停用抗凝治疗的BPH患者时,使用抗凝替代治疗和未使用抗凝替代治疗效果相当,均安全有效。

Objective To evaluate the safety and efficacy of replacement anticoagulation therapy in transurethral vaporization of the prostate using KTP laser for benign prostatic hyperplasia. Methods 103 patients in General Hospital of Navy undergoing transurethral vaporization of the prostate with KTP laser were retrospectively reviewed from September 2003 to June 2012. All cases required long term anticoagulant therapy due to underlying cardiovascular and cerebrovascular disease. All patients were divided into two groups according to whether replacement anticoagulation therapy was used or not. There were 55 cases in the replacement group and 48 cases in the non - replacement group. Factors were analyzed included operative time, requirement for blood transfusion, duration of postoperative urinary catheterization, postoperative hospital stay, and pre - and postoperative IPSS and Qmax. Results There was no significant difference in operative time [ （63. 1 ± 35. 2） minutes vs. （59.6 ± 41. 3） minutes ], duration of postoperative urinary catheterization [ （5. 2 ± 2. 3） days vs. （5. 3 ± 2.4） days ], and postoperative hospital stay [ （8. 4 ± 5. 3） days vs. （8.0 ± 6. 1） days] between two groups （t = 0.46, 0. 35, 0. 35, P 〉 0. 05） . There was no significant difference in Qmax and IPSS between two groups 1 month postoperatively （P 〉 0. 05）; however, there were significant differences in IPSS and Qmax pre - and postoperatively in both groups （P 〈 0. 05）. Conclusion KTP laser is safe and effective medium for the treatment for benign prostatic hyperplasia in patients who are anticoagulated. Replacement anticoagulation therapy and non - replacement anticoagulation therapy have the same effect and safety.