钬激光剜除术治疗复发或残留前列腺增生的可行性分析

Feasibility of Ho LEP in treatment of recurrent or residual BPH

目的探讨钬激光剜除术(HoLEP)治疗复发或残留前列腺增生(BPH)伴排便困难的有效性和安全性。方法回顾医院行HoLEP手术治疗并有随访资料的BPH患者284例,根据病史分为两组:A组(75例)接受HoLEP手术前曾有BPH手术史,其中复发64例,残留11例;B组(209例)接受HoLEP手术前无前列腺手术史。比较两组围手术期指标、手术并发症、及疗效。结果两组均成功完成HoLEP手术治疗和术后6个月复查,两组手术时间、术中失血量、膀胱冲洗时间、尿管留置时间及住院时间比较均无显著差异(P>0.05)。两组术后短期并发症发生率也无明显差异(A组14.6%vs B组11.0%,P>0.05)。排尿困难是术后发生率最高的并发症(A组5.3%vs B组3.3%),其次为尿道损伤(A组4.0%vs B组2.9%),予以相应的处理措施,所有并发症均消失或好转。术后6个月随访,两组均取得良好治疗效果,前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)及最大尿流率(Qmax)均有明显改善,组间比较无显著差异(P>0.05)。结论 HoLEP治疗复发/残留BPH是一种安全、可行且有效的治疗措施,既往有经尿道前列腺手术病史不是HoLEP手术的禁忌证。

Objective To explore the effects and safety of holmium laser enucleation of prostate （HoLEP） in the treatment of recurrent or residual benign prostatic hyperplasia （BPH） complicated with difficult defecation. Metfiods A total of 284 patients who had been suffering from BPH and had received HoLEP in our hospital as well as had follow-up data were analyzed retrospectively and divided into tw,o groups according to the medical history： group A （n=75） had BPH operation history before HoLEP, among which 64 ones had recurrent BPH and 11 ones had residual BPH; group B （n =209） had no BPH operation history before HoLEP. The perioperative indexes, operative complications and effects between the two groups were compared. Results The two groups successfully received HoLEP and reexamination six months after operation. There was no significant difference in the duration of operation, intraoperative blood loss, bladder irrigation time, urinary catheter indwelling time and length of stay （LOS） between the two groups （P 〉 0.05）. The incidence of post-operative short-term complications between the two groups also showed no significant difference （group A 14.6% vs group B 11.0%, P 〉 0.05）. The incidence of dysuria was the highest among the post-operative complications （group A 5.3% vs group B 3.3%）, and the second highest one was urethral injury （group A 4.0% vs group B 2.9%）. Corresponding measures were taken and all complications disappeared or were improved. During the six-month follow-up visit after the operation, the two groups had good effects. The international prostate symptom scores （IPSS）, quality of life （QOL） scores, post-void residual volume （PVR） and maximum flow rate （Q咖）were greatly improved and showed no significant difference between the two groups （P 〉 0.05）. Conclusion HoLEP is a safe, feasible and effective therapy for the treatment of recurrent or residual BPH. The history of transurethral resection of the prostate （TURP） is not a contraindication of HoLEP.