术中主动保护尿控功能在经尿道前列腺钬激光剜除术中的应用疗效分析

Holmium laser enucleation of prostate with intraoperative protection of urinary continence into consideration

探讨经尿道前列腺钬激光剜除术(HoLEP)术中主动保护尿控功能的临床价值。方法:对HoLEP的细节上做出一些改良,主动地部分保留前列腺前括约肌和前列腺被动括约肌,记录患者术前、术中及术后随访的临床资料,分析及评估改良后HoLEP的疗效及安全性。结果:194例手术均成功,手术时间(74.50±21.24)(47~120)min,切除腺体(44.03±15.36)(31.5~116.8)g。术后3个月和6个月的IPSS、生活质量(QOL)评分、Qmax和剩余尿量(PVR)均有明显改善,差异均有统计学意义(P<0.05)。术后6个月复查,PSA平均下降80.1%(2.72ng/ml vs.0.56ng/ml);7例(3.61%)患者出现短期的压力性尿失禁;76例有性交者中22例出现逆行射精(28.95%)。结论:经改良的HoLEP疗效安全可靠,剜除彻底,短期尿失禁等并发症减少,有望成为治疗BPH的新的金标准。

Objective：To discuss the clinical value of holmium laser enucleation of prostate（HoLEP）with intraoperative protection of urinary continence into consideration.Method：We improved HoLEP technology including preserving partial preprostatic sphincter and passive prostate sphincter,and recorded patients＇ pre-,intra-and post-operative data to analyze and assess the efficacy and safety of modified HoLEP.Result：All 194 operations were successfully performed.The operation time was（74.50±21.24）（range,47-120）min,and the weight of excised gland was（44.03±15.36）（range,31.5-116.8）g.IPSS score,QOL score,Qmaxand PVR distinctly improved in three months and six months post-operatively（P〈0.05）.PSA decreased 80.1%（2.72ng/mL vs.0.56ng/mL）.Transient stress urinary incontinence occurred in seven patients（3.61%）,while retrograde ejaculation occurred in 22 patients.Conclusion：Modified HoLEP is an effective and safe technology since it enucleates the prostate thoroughly and decreases complications such as urinary incontinence,which is expected to be a new ＂gold standard＂of BPH treatment.