经尿道钬激光前列腺剜除术和经尿道前列腺电切术治疗巨大前列腺的临床疗效比较

Transurethral holmium laser enucleationvstransurethral resection for treatment of giant prostate:a comparative study of clinical efficacy

目的:对比经尿道钬激光前列腺剜除术(HoLEP)、经尿道前列腺电切术(TURP)两种术式治疗巨大前列腺(>60 g)的临床疗效。方法:对本院本科收治的经尿道钬激光前列腺剜除术(HoLEP)、经尿道前列腺电切术(TURP)两种术式治疗巨大前列腺(>60 g)患者的100例,两种术式的临床疗效进行比较,分别统计分析两种术式在术中情况、术后情况及术后并发症的差别。结果:手术时间方面两组之间有统计学差异,HoLEP组较短,TURP组较长(P<0.05)。术中出血量方面HoLEP组与TURP组相仿。切下组织重量方面TURP组明显少于HoLEP组。留置导尿管天数方面HoLEP组与TURP组相仿。术后一月IPSS评分降低值方面两组之间无明显统计学差异(P>0.05)。术后一月最大尿流率增加值方面HoLEP组较TURP组增加值多。术后再出血例数两组之间无明显统计学差异(P>0.05)。尿失禁例数TURP组低于HoLEP组。尿道狭窄例数两组之间无明显统计学差异。结论:两种术式均能安全有效地治疗巨大前列腺。TURP手术创伤小;HoLEP手术时间短、术中出血少,相对应手术创伤小,但术后早期尿失禁发生率高。

Objective：To compare the efficacy of transurethral holmium laser enucleation of the prostate（HoLEP） vs transurethral resection of the prostate（TURP） for treatment of giant prostate 〉 60 g.Methods：100 patients with giant prostate（〉60g） were treated with HoLEP or TURP in our Department of Urology.The clinical efficacy of the two treatment options was compared.The differences in intraoperative and postoperative events and postoperative complications between HoLEP and TURP were analyzed statistically.Results：There was a statistically significant difference in operative time between the two groups,which was shorter in the HoLEP group and longer in the TURP group.The blood loss was comparable between HoLEP and TURP groups.Significantly less resected tissue was weighted with TURP than with HoLEP.Days of catheter indwelling and reduction in IPSS at 1-month were similar between the HoLEP and TURP groups.Patients treated with HoLEP had greater increase in maximum urinary flow rate at1 month after operation than those treated with TURP.There was no statistical difference between the two groupsin re-bleeding after operation,but fewer patients treated with TURP experienced urinary incontinence compared with those treated with HoLEP.The two treatment options did not differ in urethral stricture.Conclusion：The two methods are safe and effective for treatment of giant prostate.TURP is associated with little surgical trauma.HoLEP is associated with shorter operation time and less intraoperative blood loss,but a higher incidence of urinary incontinence early after surgery.