经尿道选择性绿激光汽化术与前列腺等离子电切术治疗高危高龄BHP患者的随机对照研究

Evaluation of Greenlight Photoselective Vaporization of Prostate and Plasmakinetic Resection of Prostate for the Treatment of Eldly Benign Prostatic Hyperplasia Men with High Surgical Risk:a Prospective Randomised Control Trial

目的对比经尿道选择性绿激光汽化术(PVP)与前列腺双极等离子切除术(PRP)治疗高危高龄良性前列腺增生症(BHP)患者的临床疗效及安全性,并总结预防控制术后并发症的经验。方法将53例年龄≥75岁且合并内科性疾病又需要手术治疗的BHP患者随机分入PVP组(25例)及PRP组(28例),记录患者膀胱出口梗阻的指标〔国际前列腺症状评分(IPSS)、最大尿流率(Qmax);残余尿(PVR)、生活质量(QOL)评分〕、前列腺体积(PV)、手术时间、术中出血量、术后恢复指标(术后膀胱冲洗时间、留置尿管时间、术后住院时间)、术后3月膀胱出口梗阻的改善及并发症的发生情况,两组间进行比较。结果两组术中出血量、术后膀胱冲洗时间、留置尿管时间、术后住院时间等对比显示差异具有统计学意义(P<0.002):术中出血量PVP组少于PRP组;术后膀胱冲洗时间、留置尿管时间、术后住院时间PVP组均短于PRP组。手术时间对比差异无统计学意义(P=0.12)。44例患者获得完整随访数据,其中PVP组21例,PRP组23例。术后3月两组组间在膀胱出口梗阻的指标(IPSS、Qmax、残余尿、QOL评分)对比差异无统计学意义(P>0.05),PVP组发生2例并发症,PRP组发生4例并发症。结论PVP和PRP治疗高危高龄患者BPH,在良好控制内科合并症的情况下都安全有效。对于前列腺体积大的重度BPH患者,建议首选PRP。而手术风险高者,可选择PVP。

Objective To compare the clinical effects and safety between greenlight photoselective vaporization of prostate（PVP）and plasmakinetic resection of prostate（PRP）in eldly benign prostatic hyperplasia（BPH）men with high surgical risk.Methods Fifty three eldly BPH patients,who had the indication of surgical treatment but complicated with at least one internal disease,were randomly divided into PVP group and PRP group.The clinical data of all the patients were collected and compared between the two groups,including pre-operative and post-operative international prostate symptom score（IPSS）,postvoid residual urine（PVR）,urine flow rate（Qmax）,quality of life（QOL）as well as prostate volume（PV）,operational time,operative bleeding volume,postoperative recovery,peri-operative complications.Results The complete follow-up data of 44 patients were achieved：21of PVP,23of PRP.There were significant differences between two groups in operative bleeding、bladder irrigation time、indwelling catheter time and hospital stay（P＆lt;0.002）.The peri-operative bleeding was lower in PVP group,while the bladder irrigation time、indwelling catheter time and hospital stay were shorter in PVP group.The operation time showed no difference（P=0.12）.No significant differences were found 3months postoperatively between two groups in all the data associated with urination（IPSS,Qmax,PVR,QOL）,P＆gt;0.05.Complications（urethrostenosis,retrograde ejaculationwere acceptable in both groups.Conclusion For surgical treatment of eldly men with high surgical risk,both PVP and PRP are safe and effective with the internal disease being sufficient control.