钬激光剜除与经典经尿道前列腺切除术在逼尿肌功能不全患者中手术结果的比较

Comparison of surgical outcomes between holmium laser enucleation and classical transurethral resection of the prostate in patients with detrusor underactivity

目的比较逼尿肌功能不全(detrusor underactivity,DU)患者钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)和经尿道前列腺切除术(transurethral resection of prostate,TURP)的短期手术结果。方法回顾性分析新疆维吾尔自治区人民医院2010年1月至2015年5月,352例患者接受单一外科治疗组医师进行HoLEP或TURP。其中56例患有良性前列腺增生症和DU的患者参与了本研究(HoLEP组,24例;TURP组,32例)。回顾性比较两组的术后结果。DU被定义为通过压力流率研究测量的最大流速时逼尿肌压力小于40 cmH_2O。结果两组患者的术前特征和合并症相似。TURP组的手术时间明显短于HoLEP组(P=0.033)。HoLEP组切除的前列腺重量较大,HoLEP组的术后排尿参数(包括峰值流量和尿后残余尿量)明显优于TURP组。结论 HoLEP可以在DU患者中有效且安全地进行,并且在下尿路症状改善方面预期手术结果比TURP好。

Objective To compared the short-term surgical outcomes of holmium laser enucleationof the prostate （ HoLEP） and transurethral resection of the prostate （ TURP） in patients with detrusor underactivity （ DU）. Methods Retrospectively analysis from Jan. 2010 to May 2015 , 352 patients underwent HoLEP or TURP in procedures performed by a single surgeon. Of these patients, 56 patients withboth BPH and DU were enrolled in this study （HoLEP,n = 24; TURP,n = 32）. Surgical outcomes wereretrospectively compared between the two groups. DUwas defined as a detrusor pressure at maximal flow rateof 〈 40 cmH2O as measured by a pressure flow study. Results The preoperative characteristics of patientsand the presence of comorbidities were comparable between the 2 groups. The TURP group showed asignificantly shorter operative time than the HoLEP group （P = 0. 03）. The weight of the resected prostawas greater in the HoLEP group, and postoperative voiding parameters, including peak flow rate and postvoidresidual urine volume were significantly better in the HoLEP group than in the TURP group. ConcHoLEP can be effectively and safely performed in patients with DU and can be expected to have bettersurgical outcomes than TURP in terms of the improvement in lower urinary tract symptoms.