经尿道选择性绿激光汽化术与经尿道等离子电切术治疗大体积前列腺增生的比较

Green Light laser photoselective vaporization versus bipolar transurethral resection for prostates Larger than 80 mL: a randomized controlled trial with 2 years follow-up

目的:研究经尿道绿激光前列腺汽化术治疗>80 mL前列腺增生的有效性和安全性。方法:80例大体积前列腺增生患者随机平均分为两组,分别接受经尿道选择性绿激光汽化术和经尿道双极等离子电切术,比较两组的手术情况、疗效和并发症。结果:绿激光组的手术时间长于电切组(P<0.05);血钠下降和血红蛋白下降少于电切组(P<0.05),留置导尿时间和住院时间短于电切组(P<0.05)。绿激光组低钠血症和电切综合征发生率低于电切组(P<0.05);而包膜穿孔、急迫性尿失禁、压力性尿失禁和尿道狭窄的发生率两组差异无统计学意义(P>0.05)。在术后1、6、12、24个月各个随访时间点,两组的国际前列腺症状评分、生存质量指数评分、最大尿流率和残余尿量差异无统计学意义(P>0.05)。结论:经尿道光选择性绿激光汽化术治疗>80 mL前列腺增生,疗效与经尿道双极等离子电切术相当;而安全性更高,患者耐受性更好。

Objective To assess the efficacy and safety of GreenLight laser photoselective vaporization versus bipolar transurethral resection for prostates Larger than 80 mL. Methods 80 patients with prostate hyperplasia larger than 80 mL were randomized to undergo GreenLight laser photoselective vaporization （PVP） or bipolar transurethral resection （TURP）. Operative outcome, therapeutic efficacy and complications were compared. Results （1）The operative time was significantly longer in the PVP group （P 〈 0.05）. Decrease in blood sodium and hemoglobin was less in the PVP group （P 〈 0.05）. Catheterization time and postoperative hospital stay was significantly shorter in the PVP group （P 〈 0.05）. （2）The rate of hyponatremia and transurethral resection syndrom was less in the PVP group （P 〈 0.05）;but no significant difference was seen in the incidence of capsular perforation, urgent incontinence, stress incontinence and urethral stricture（P 〉 0.05）. （3）No significant difference was detected in International Prostate Symptom Score, quality of life, maximal flow rate and post-void residual urine volume between the 2 groups at 1, 6, 12 and 24 months（P 〉 0.05）. Conclusion GreenLight laser photoselective vaporization is as effective as bipolar transurethral resection for the treatment of prostate hyperplasia Larger than 80 mL, showing higher safety and better tolerance.