经尿道钬激光与等离子前列腺剜除术的比较

Comparative Study Between Holmium Laser Enucleation and Transurethral Plasma Kinetic Enucleation for Benign Prostatic Hyperplasia

目的比较经尿道钬激光前列腺剜除术(holmium laser enucleation of the prostate,Ho LEP)和经尿道等离子前列腺剜除术(transurethral plasma kinetic enucleation of prostate,TUPKEP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的效果。方法回顾性分析2014年6月~2016年11月98例BPH资料,按患者意愿选择术式。50例行Ho LEP,48例行TUPKEP,比较2组手术指标及术后3个月生活质量(quality of life,QOL)评分,最大尿流率(Qmax),国际前列腺症状评分(international prostate symptom score,IPSS),残余尿量(residual urine volume,RUV)。结果与TUPKEP组比较,Ho LEP组手术时间长[(76.5±12.8)min vs.(57.9±18.3)min,t=5.850,P=0.000],但术中出血少[(128.5±32.7)ml vs.(188.7±39.5)ml,t=-8.232,P=0.000],膀胱冲洗时间、尿管留置时间、住院时间短[(2.6±0.9)d vs.(3.5±0.3)d,t=-6.585,P=0.000;(2.8±1.2)d vs.(4.6±1.4)d,t=-6.843,P=0.000;(5.7±1.1)d vs.(8.2±1.6)d,t=-9.045,P=0.000],2组总体术后并发症发生率无显著性差异(P>0.05)。术后3个月,2组IPSS、QOL评分、Qmax、RUV均较术前明显改善(P=0.000),但2组之间差异无统计学意义(P>0.05)。结论两种术式治疗BPH均安全、有效、微创。相比较而言,Ho LEP在安全性、术后恢复时间等方面更有优势。

Objective To compare the safety and efficacy between holmium laser enucleat ion of the prostate （Ho LEP ） and transurethral plasma kinetic enucleation of prostate （TUPKEP） for the treatment of benign prostatic hyperplasia （BPH）. Methods A total of 98 patients with BPH from June 2014 to November 2016 were retrospectively analyzed. All the patients were divided into either HoLEP groups （50 cases） or TUPKEP groups （48 cases） according to patient ’ s wishes. The operation data and therapeutic results such as international prostate symptom score （IPSS） , quality of life（QOL） score, Qmax, and residual urine volume （RUV） in 3 months after operation were compared and analyzed. Results The time of operation for HoLEP was longer than that for TUPKEP [（76.5 ±12.8） min vs. （57.9 ±18.3） min, t = 5. 8 5 0 , P = 0. 000 ] . However, the blood loss in o p e ra t io n , the time of b lad der irrigating after operation, the time of catheterization, and hospital stay time were less in HoLEP group than those in TUPKEP group [（128.5 ±32. 7） ml vs. （188.7 ±39.5） = - 8. 232,尸= 0 . 0 0 0 ; （ 2 . 6 ± 0. 9 ） d vs. （ 3 . 5 ± 0. 3 ） = - 6. 585 , 尸=0. 000; （2. 8 ± 1.2） d vs. （4.6 ± 1.4） d, t= - 6. 8 4 3 , P = 0 . 0 0 0; （ 5 . 7 ± 1. 1） d vs. （ 8 . 2 ± 1 .6 ） d , t= - 9 . 0 4 5 , P = 0 . 0 0 0 ] . There was no significant difference in the overall postoperative complication rate （ P 〉 0. 05 ） . The IPSS, QOL score, Qmax and RUV were significantly improved after 3 months postoperatively in both groups （ P = 0. 000 ） , but there were no significant differences between the two groups （P 〉 0. 05）. Conclusions Both surgical trea tment of BPH are s a f e , effective and minimal invasive. In comparison, HoLEP has more advantages in terms of safety and postoperative recovery.