铥激光在经尿道前列腺剜除术中出血量的观察

Clinical observation of blood loss during thulium laser vapoenucleation of the prostate

目的：比较经尿道前列腺铥激光剜除术（ThuVEP）与经尿道等离子双极电切剜除术（PKEP）、经尿道普通电切剜除术（TUEP）术中及术后的失血量。方法：我院2007年10月2015年3月间收治BPH患者405例,其中177例行TUEP（TUEP组）,35例行PKEP（PKEP组）,193例行ThuVEP（ThuVEP组）,并收集术前血红蛋白（Hb）和红细胞压积（HCT）、手术时间、术后HB和HCT、膀胱冲洗时间、留置尿管时间。结果：TUEP组手术时间（112.0±31.3）min,术后Hb下降量为（12.4±7.5）g/L,HCT下降量为（5.5±3.8）%;PKEP组手术时间（109.4±42.4）min,术后Hb下降量为（11.4±8.7）g/L,HCT下降量为（3.2±2.4）%;ThuVEP组手术时间（106.1±36.0）min,术后Hb下降量为（7.0±7.5）g/L,HCT下降量为（3.1±3.5）%。三组手术时间差异无统计学意义（P〉0.05）;ThuVEP组与其他两组术后Hb下降量比较,差异有统计学意义（P〈0.01）;与TUEP组术后HCT下降量比较,差异有统计学意义（P〈0.01）;与PKEP组术后HCT下降量比较,差异无统计学意义（P〉0.05）;术后膀胱冲洗时间及留置尿管时间比较,ThuVEP组时间最短,其次为PKEP组,三组中两两比较,差异均有统计学意义（P〈0.01）。结论：相比TUEP、PKEP,ThuVEP术中出血量及术后出血量更少。

Objective： To compare intraoperative and postoperative blood loss among three surgical methods thulium laser vapoenucleation of the prostate （ThuVEP）, plasmakinetic enucleation of prostate （PKEP） and con- ventional transuretbral enucleation of the prostate （TUEP）. Method.. From October 2007 to March 2015, 177 BPH cases treated with TUEP, 35 BPH cases underwent PKEP, and 193 BPH patients received ThuVEP. Preop- erative Hb, preoperative HCT, operative time, postoperative Hb, postoperative HCT, time of bladder irrigation, catheter retention time were collected and compared among three groups. Result： The difference was not signifi- cant in average operative time among TUEP, PKEP and ThuVEP （ P 〉0.05）. The decrease of Hb in patients undergoing ThuVEP was significantly less than that in PKEP or TUEP （ P 〈0.01）. The decrease of HCT in patients undergoing TUEP was significantly more than that in ThuVEP （ P d0.01）, but there was no significant difference between PKEP and ThuVEP （ P 〈0.05）. In the time of bladder irrigation and catheter retention, the difference between pairwise comparisons showed statistical significance （ P 〈0.01）. Patients with ThuVEP expe- rienced the shortest bladder irrigation and catheter retention time, and were followed by patients with PKEP. Con- clusion： Compared with TUEP and PKEP, less intraoperative and postoperative blood loss could be found in Thu- VEP.