经尿道2μm激光剜除术与等离子电切术治疗大体积前列腺增生临床分析

Transurethral 2μm laser enucleation and plasma kinetic resection of prostate for large-volume benign prostatic hyperplasia

目的比较经尿道2μm激光与等离子电切术治疗大体积前列腺增生的临床疗效及安全性。方法 87例前列腺体积>80mL前列腺增生患者,经尿道2μm激光前列腺剜除术治疗的47例为激光组,行离子电切术治疗的40例为电切组;比较2组手术时间、术中出血量、术后膀胱持续冲洗时间、导尿管留置时间、住院时间;观察2组手术前、后生活质量评分(quality of life,QOL)、国际前列腺症状评分(International Prostate Symptom Score,IPSS)、残余尿量(postvoid residual urine,PVRU)、最大尿流率(maximum urinary flow rate,Qmax)及术后并发症发生情况。结果 2组手术时间比较差异无统计学意义(P>0.05),激光组术中出血量[(59.2±15.3)mL]少于电切组[(91.3±14.6)mL],术后膀胱持续冲洗时间[(2.1±0.4)d]、导尿管留置时间[(3.9±0.8)d]、住院时间[(7.9±0.6)d]短于电切组[(2.9±0.6)d、(5.2±0.6)d、(9.5±0.4)d](P<0.05);激光组和电切组术后3个月QOL[(1.2±0.6)分、(1.4±0.7)分]、IPSS[(5.5±1.8)分、(5.6±1.5)分]低于术前[QOL(5.2±0.1)、(5.1±0.6)分,IPSS(25.5±2.5)、(24.8±3.3)分],PVRU[(16.8±8.4)mL、(17.2±9.2)mL]少于术前[(112.6±47.6)、(118.2±39.7)mL),Qmax[(5.3±1.5)mL/s、(5.0±1.1)mL/s]较术前减慢[Qmax(7.5±2.5)、(7.4±2.3)mL/s](P<0.05),但组间比较差异均无统计学意义(P>0.05);激光组术后并发症发生率(2.22%)低于电切组(29.73%)(P<0.05)。结论 2μm激光和离子电切均是治疗大体积前列腺增生的有效方法,2μm激光前列腺剜除术具有出血少、恢复快、并发症少等优点。

Objective To compare the therapeutic effect and safety of transurethral 2 μm laser enucleation and plasma kinetic resection of prostate （PKRP） for large-volume benign prostatic hyperplasia （BPH）. Methods Eighty-seven patients with large-volume BPH （=80 mL） were divided into laser group receiving transurethral 2 μm laser enucleation （n=47） and PKRP group receiving PKRP （n=40）. The operation lasting time, intra-operative blood loss, continuous bladder irrigation time, catheterization time, hospitalization stay, quality of life （QQL） score, International Prostate Symptom Score （IPSS）, postvoid residual urine （PVRU）, maximum urinary flow rate （Qmax） and postoperative complications were analyzed and compared between two groups. Results There was no significant difference in the operation lasting time between two groups （P〈0.05）. The intra-operative blood loss （（59.2± 15.3） mL） was less, and continuous bladder irrigation time （（2.1± 0.4） d）, catheterization time （（3.9 ± 0.8） d） and hospitalization stay （（7.9 ± 0.6） d） were shorter in laser group than those in PKRP group （（91.3±14. 6） mL, （2. 9±0. 6） d, （5. 2±0. 6） d, （9.5±0.4） d） （P〈0.05）. The scores of QOL （1.2±0.6, 1.4±0.7） and IPSS （5.5±1.8, 5.6±1.5） were lower, PVRU （（16.8±8.4）, （17.2±9.2） mL） were smaller, and Qmax （（5.3±1.5）, （5.0±1.1） mL/s） after operation were slower than those before operation （QOL： 5.2±0.1, 5.1±0.6; IPSS.. 25.5±2.5, 24.8±3.33 PVRU： （112.6± 47.6）, （118.2±39.7） mL-1 Qmax： （7.5±2.5）, （7.4±2.3） mL/s） in laser group and PKRP group （P〈0.05）, and there were no significant differences between two groups （P〈0.05）. The incidence of complications was lower in laser group （2 22 %） than that in PKRP group （29.73 %） （P〈0.05）. Conclusion Both transurethral 2 μm laser enucleationand PKRP are effective for large-volume BPH. Transurethral 2 μm laser has the advantages of less bleeding, faster recovery and fewer complications.