1470 nm激光前列腺汽化与剜除术中灌注液吸收对内环境的影响

Effects of irrigation fluid's absorption on 1470 nm diode laser enucleation versus vaporization for benign prostate hyperplasia

目的探讨经尿道1 470 nm半导体激光前列腺汽化术(Di VAP)与剜除术(Di VEP)术中灌注液吸收对机体安全性的影响。方法 2016年7月至2017年2月,我院40例前列腺增生(BPH)患者被随机分成两组,分别进行Di VAP及Di VEP治疗。比较两组患者手术时间、灌注液使用量、灌注液吸收量、术后膀胱持续冲洗时间、术后尿管保留时间、术后住院时间、血红蛋白、电解质、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿(PVR)、并发症等。结果两组患者年龄、前列腺体积、术前IPSS评分、PVR、Qmax及平均手术时间、灌注液使用量、术后膀胱持续冲洗时间、术后尿管保留时间、术后住院时间差异均无统计学意义(P>0.05)。Di VAP组与Di VEP组术后血红蛋白下降值分别为(1.9±1.0)g/L vs(12.3±11.3)g/L(P=0.001),Di VAP组监测到灌注液吸收3例,平均吸收量675(356~1 078)ml,Di VEP组监测到灌注液吸收10例,平均吸收量2 089(187~7 240)ml,差异均有统计学意义(P<0.05)。两组患者手术前后血清K+、Na+变化差异无统计学意义,血红蛋白下降有统计学意义(P<0.05)。两组患者术后IPSS、QOL、Qmax及PVR比较差异无统计学意义,两组术后并发症发生率差异无统计学意义。结论经尿道1 470 nm半导体激光前列腺汽化与剜除术均是治疗(BPH)的有效术式,但汽化术中灌注液吸收与失血量更少。

Objective To investigate the effect of intraoperative absorption of irrigation fluid on the safety of transurethral vaporization of prostate（Di VAP） and enucleation of prostate（Di VEP） with 1470 nm semiconductor laser. Methods From July 2016 to February 2017, 40 patients with benign prostatic hyperplasia（BPH） admitted to our hospital were randomly divided into the Di VAP and Di VEP groups. The operation time, irrigation fluid volume, irrigation fluid absorption volume, postoperative persistent irrigation time of bladder, postoperative retention time of urinary catheter, postoperative length of hospital stay, hemoglobin, electrolyte, international prostate symptom score（IPSS）, quality of life（QOL） score, maximum urinary flow rate（Qmax）, post-void residual urine volume（PVR） and postoperative complications were statistically compared between two groups. Results No statistical significance was noted in age, prostate volume, preoperative IPSS score, PVR, Qmax, mean operation time, irrigation fluid volume, postoperative persistent irrigation time of bladder, postoperative retention time of urinary catheter and postoperative length of hospital stay between two groups（all P〈0.05）. After corresponding surgery, thehemoglobin level in the Di VAP group was（1.9±1.0） g/L, significantly lower than（12.3±11.3） g/L in the Di VEP group（P=0.001）. In the Di VAP group, irrigation fluid absorption was monitored in 3 cases with an average absorption volume of 675（356-1 078） ml. In the Di VEP group, irrigation fluid absorption was observed in 10 cases with a mean absorption volume of 2 089（187-7 240） ml with statistical significance between two groups（P〈0.05）. In both groups, the serum levels of K＋ and Na＋ did not significantly differ before and after surgery, whereas the hemoglobin level was significantly decreased（P〈0.05）. The IPSS,QOL, Qmax, PVR and the incidence of postoperative complications did not significantly differ between two groups. Conclusion Both Di VAP and Di VEP with 1 470 nm semiconductor laser are efficacious methods for the treatment of BPH, whereas Di VAP yields less irrigation fluid absorption and blood loss intraoperatively.