2 μm激光前列腺汽化切除术与等离子前列腺电切术的随机对照研究

Comparison of 2 μm Continuous-wave Laser Vaporesection and Transurethral Resection of the Prostate: a Randomized Controlled Trial

目的比较2μm激光前列腺汽化切除术与经尿道等离子前列腺电切术治疗良性前列腺增生（benign prostatic hyperplasia,BPH）的效果。方法采用密闭信封法将2013年10月～2014年12月62例BPH分为电切组（35例,经尿道等离子前列腺电切术）和激光组（27例,Revo Lix 2μm激光前列腺汽化切除术）。比较2组手术时间、术中出血量、术后膀胱冲洗盐水量、术后导尿管留置时间、住院时间及并发症;比较2组术后3个月国际前列腺症状评分（international prostate symptom score,IPSS）、前列腺增生生活质量评分（quality of life,QOL）、最大尿流率（Qmax）及膀胱残余尿量（post-void residual volume,PVR）。结果 2组手术时间差异无显著性（P〉0.05）。激光组术中出血量、术后膀胱冲洗液用量、术后导尿管留置时间及住院时间、并发症发生率均明显优于电切组[（202.4±44.2）ml vs.（750.5±86.3）ml,t=-30.061,P=0.000;（9.5±2.1）L vs.（22.1±5.3）L,t=-11.650,P=0.000;（1.7±0.3）d vs.（3.4±0.6）d,t=-13.464,P=0.000;（4.2±1.3）d vs.（6.7±1.4）d,t=-7.190,P=0.000;3.7%（1/27）vs.25.7%（9/35）,χ2=3.953,P=0.047）]。治疗后3个月,2组IPSS及QOL评分、Qmax、PVR均较治疗前改善（P〈0.05）;激光组IPSS评分和残余尿量小于电切组[（6.5±1.2）分vs.（7.2±1.3）分,t=-2.173,P=0.033;（22.4±6.4）ml vs.（45.3±13.2）ml,t=-8.284,P=0.000]。结论2μm激光汽化切除术治疗BPH安全、有效,可更好地减少残余尿量,改善术后生活质量,值得临床推广应用。

Objective To compare the efficacy of 2 μm laser vaporization and transurethral resection of prostate for the treatment of benign prostatic hyperplasia（ BPH）. Methods Sixty-two patients from October 2013 to December 2014 were randomly divided into resection group（ 35 cases）,which was treated by transurethral resection,and vaporization group（ 27 cases）,which was treated by Revo Lix 2 μm laser vaporization. All the subjects were grouped by sealed envelope technique. The operation time,bleeding volume,postoperative bladder irrigation water volume,postoperative catheter indwelling time,hospitalization time and complications of the two groups were compared. The international prostate symptom score（ IPSS）,quality of life（ QOL） scores,Qmax and bladder post-void residual volume（ PVR） at 3 months after treatment were also compared between the two groups. Results There was no difference in the operation time between the two groups（ P〈0. 05）. The bleeding volume,postoperative bladder irrigation fluid volume,postoperative catheter indwelling time,hospitalization time and complication rate were all better in the vaporization group than in the resection group [（ 202. 4 ± 44. 2） ml vs.（ 750. 5 ± 86. 3） ml,t =- 30. 061,P = 0. 000;（ 9. 5 ± 2. 1） L vs.（ 22. 1 ± 5. 3） L,t =- 11. 650,P = 0. 000;（ 1. 7 ± 0. 3） d vs.（ 3. 4 ± 0. 6） d,t =- 13. 464,P = 0. 000;（ 4. 2 ± 1. 3） d vs.（ 6. 7 ± 1. 4） d,t =- 7. 190,P = 0. 000; 3. 7%（ 1 /27） vs. 25. 7%（ 9 /35）,χ2= 3. 953,P = 0. 047） ]. Moreover,the IPSS scores,QOL scores,Qmax and PVR were improved in both groups at 3 months after treatment（ P〈0. 05）. The IPSS scores and PVR in the vaporization group were better than those in the resection group after operation [（ 6. 5 ± 1. 2） points vs.（ 7. 2 ± 1. 3） points,t =- 2. 173,P =0. 033;（ 22. 4 ± 6. 4） ml vs.（ 45. 3 ± 13. 2） ml,t =- 8. 284,P = 0. 000]. Conclusion The 2 μm laser vaporization resection in the treatment of BPH is safe and effective,which can significantly reduce the PVR and improve postoperative quality of life,being worthy of clinical application.