1470nm半导体激光前列腺汽化术与经尿道前列腺电切术治疗良性前列腺增生的效果比较

A comparative study on the clinical effects of 1470 nm diode laser vaporization and transurethral resection of the prostate for benign prostatic hyperplasia

目的比较1470nm半导体激光前列腺汽化术与经尿道前列腺电切术（TURP）治疗良性前列腺增生（BPH）的安全性和手术疗效。方法2014年7月至2015年7月共人组82例BPH患者，40例行经尿道1470nm半导体激光前列腺汽化术，42例接受TURP术。观察记录两组患者手术时间、血红蛋白降低值、血钠降低值、膀胱冲洗时间、留置尿管时间、手术并发症、术前和术后国际前列腺症状评分（IPSS）、残余尿量（PVR）和最大尿流率（Qmax），并进行综合分析比较。结果两组患者的年龄、前列腺体积、IPSS评分、PVR和Qmax等术前指标进行比较，差异均无统计学意义（P均〉0．05）。I470nm激光组手术平均时间与TURP组比较差异无统计学意义[（64．8±14．6）min与（59．3±14．5）min，P〉0．05]。1470nm激光组术后血红蛋白平均下降值[（2．06±1．43）g／L与（6．07±1．68）g／L]、血钠平均下降值[（1．16±0．67）mmol／L与（4．09±3．78）mmol／L]、术后平均膀胱冲洗时间[（5．08±2．80）h与（25．8±12．7）h]、术后平均留置尿管时间[（3．38±1．17）d与（4．88±1．42）d]，与TURP组比较差异均有统计学意义（t值分别为-11．615、-4．845、-10．337和-5．232；P均〈0．001）。1470nm激光组与TURP组手术并发症情况比较差异均无统计学意义（P均〉0．05）。术后随访3～12月1470nm激光组与TURP组比较，IPSS评分：F组内=527．65，P〈0．001；F组间=0．099，P=0．753；F交互=0．040，P=0．843、PVR：F组内=509．57，P〈0．001；F组间=2．817，P=0．097；F交互=1．02，P=0．315、Qmax：F组内=60．06，P〈0．001；F组间=0．30，P=0．585；F交互=0．394，P=0．532。结论1470nm半导体激光前列腺汽化术能显著改善患者下尿路症状，近期疗效同TURP相似，且具有出血少、安全性高、术后留置尿管时间短及恢复快等优点，是一种治疗BPH安全有效的新方法。

Objective To compare the safety and efficacy of 1 470 nm diode laser vaporization of the prostate with transurethral resection of the prostate （TURP） in patients with benign prostatic hyperplasia （BPH）. Methods From July 2014 to July 2015,82 patients diagnosed as BPH were randomly divided into two groups. Forty cases of them underwent 1 470 nm diode laser vaporization and 42 cases for TURP. The operation time, hemoglobin decrease, serum sodium decrease, bladder irrigation time, duration of bladder catheterization and postoperative complications were recorded. The international prostate symptom score （IPSS）, maximum flow rate （Qmax） and post-voiding residual volume （PVR） before and after operation were compared. Results No differences were found between the two groups in basic preoperative characteristics, such as： age, prostate volume,IPSS,PVR and Qmax（P〉0. 05）. The mean operative time in the diode laser group was （64. 8±14. 6） min, slightly longer than tin he TURP group （ （59. 3± 14. 5 ） min, P〉0. 05 ）. The hemoglobin decrease, the serum sodium decrease, the time of bladder irrigating and the time of catheterization of 1470 nm diode laser group were all less than that in TURP group, the differences were significant between the two groups（ （2. 06±1.43 ） g/L vs. （6.07±1.68） g/L, （ 1.16±0. 67） inmol/L vs. （4.09±3.78） retool/L, （5.08±2. 80） h vs. （25.8± 12. 7 ） h, （3. 38±1.17） d vs. （4. 88±1.42） d,respectively;t = -11. 615,-4. 845, -10. 337, -5. 232;P〈0. 001）. The complications in 1470nm diode laser group were less than that in TURP group, but the differences were not significant between the two groups （P〉0. 05）. All patients were followed up for 3-12 months, the IPSS, PVR and Qmax of 3 months after surgery in 1 470 nm diode laser group and TURP group were all improved significantly compared with that of preoperative in both groups,but no statistical differences could be found between the two groups （ IPSS ： F inner grouP = 527. 65, P〈0. 001 ; F between groups = 0. 099, P = 0. 753 ; F across groups = 0. 040, P = 0. 843, PVR： F inner grouP = 509. 57, P 〈 0. 001 ; F between groups =2. 817, P = 0. 097 ; F across groups = 1.02, P = 0. 315 ; Qmax ： inner grouP = 60. 06,P〈 0. 001 ; F between groups = 0. 30, P = 0. 585 ; F across groups =0. 394,P=0. 532）. Conclusion 1 470 nm diode laser vaporization of the prostate can significantly improve the patient＇s lower urinary tract obstruction symptoms, which show similar short-term effects with TURP. It also has advantages of less bleeding, shorter catheter indwelling time and rapid postoperative recovery compared with TURP, suggesting that it is a safe and effective operation for BPH treatment.