铥激光“两点一线一面”剜除术治疗良性前列腺增生的研究分析

Research on the effect of “two points,one border and one layer” principle applied in thulium laser enucleation of prostate surgery

目的:探讨"两点一线一面"手术原则在铥激光前列腺剜除术(ThuLEP)中的应用效果。方法:回顾性分析2017年1月~2018年2月我院收治的良性前列腺增生(BPH)行ThuLEP患者的临床资料,所有病例均按照"两点一线一面"原则行手术治疗。对比手术前后血红蛋白值、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Q_(max))及残余尿量(PVR)等变化差异,统计术后尿失禁发生率。结果:研究共纳入患者66例,平均年龄75岁。术前平均前列腺体积(58.5±12.6)ml,术中无明显出血,平均总体手术时间(57.4±16.2)min,平均剜除时间(47.4±15.2)min,平均组织粉碎时间(9.3±7.6)min,术后导尿管留置时间(1.9±0.5)d,术后住院(2.5±1.0)d。拔管当日尿失禁发生率21.2%(14/66),通过提肛训练后均完全恢复。术后3个月随访表明,IPSS评分降低67%,QOL评分提高73%,Q_(max)上升210%,PVR减少85%。术后3个月患者IPSS、QOL、Q_(max)、PVR均较术前显著改善(P<0.05)。结论:铥激光"两点一线一面"剜除术具有剜除效率高、出血少、恢复快以及排尿功能改善好等优点,是治疗BPH的一种理想选择。

Objective：To evaluate the effect of＂two points,one border and one layer＂principle on thulium laser enucleation of prostate（ThuLEP）.Method：Data from consecutive benign prostatic hyperplasia（BPH）patients between January 2017 and February 2018 were retrospectively reviewed.All cases were performed ThuLEP surgery following the＂two points,one border and one layer＂principle.Their perioperative data were compared.Result：A total of 66 patients were enrolled in the current study.Their average age was 75,and prostate volume was（58.5±12.6）ml.The overall operation time was（57.4±16.2）min.The enucleation time was（47.4±15.2）min and the morcellation time was（9.3±7.6）min.The catheterization time was（1.9±0.5）days.The average postoperative stay was（2.5±1.0）days.The＂two points,one border and one layer＂principle was applied in all surgeries.On the three months follow-up,QOL score and Qmax improved significantly while IPSS score and PVR dropped dramatically.The incontinence rate was 21.2%（14/66）on the day of removing the urethral catheter and all patients improved significantly through levator ani exercises.At 3-month follow up,the patients＇ IPSS,QOL,Qmax and PVR significantly improved（P〈0.05）.Conclusion：ThuLEP following ＂two points,one border and one layer＂principle is an ideal treatment for BPH,for it is proved to be high efficacy,less bleeding,faster recovery and better improvement.