经尿道摩西钬激光前列腺剜除术治疗良性前列腺增生的初步探讨——附31例报告

Preliminary Study of Transurethral Moxi Laser Decompression for Benign Prostatic Hyperplasia——Attached Report of 31 Cases

目的探讨经尿道摩西钬激光前列腺剜除术治疗良性前列腺增生的安全性及疗效。方法方便选取该院2018年8—11月应用摩西钬激光及医用手术刨削器经尿道前列腺剜除术治疗31例良性前列腺增生患者,对手术时间、术中出血量、剜除前列腺腺体重量、术后留置尿管时间、术后住院时间等指标进行统计分析,并对术前及术后3个月的最大尿流率(peak urinary flow rate,Qmax)、残余尿量(residual urine volume,PVR)、国际前列腺症状评分(international prostate symptom score,IPSS)等随访资料进行比较分析。结果31例患者手术均获得成功,手术时间平均(65.80±17.50)min,术中出血量平均(40.0±12.87)mL,剜除前列腺腺体重量平均(32.0±3.84)g,术后留置尿管时间平均3.0 d,术后平均住院时间4.73 d,患者术后3个月的Qmax(19.38±2.13)mL/s较术前(6.81±2.42)mL/s显著增高,差异有统计学意义(t=-19.280,P<0.001),而患者术后3个月的PVR(8.71±1.04)mL、IPSS(5.13±0.61)分较术前PVR(225.58±22.37)mL、IPSS(23.0±2.76)分明显降低,差异有统计学意义(t=53.920,P<0.001;t=15.710,P<0.001)。术中均无膀胱损伤及TUR综合征患者,无输血患者,术后无尿失禁和尿道外口狭窄患者,1例患者拔除尿管后出现排尿困难,重新留置尿管5 d再拔除尿管排尿通畅,术后1例病理诊断为前列腺癌,术后3个月予施行腹腔镜前列腺根治术。结论经尿道摩西钬激光前列腺剜除术安全性高、风险较小、疗效良好、适应证广泛,术后留置尿管、住院时间短,患者康复快,学习曲线较短。

Objective To evaluate the safety and efficacy of transurethral Moses holmium laser prostatectomy for benign prostatic hyperplasia.Methods Clinical data of 31 patients with benign prostatic hyperplasia admitted and treated in the hospital from August to November 2018 were conveniently selected.The operative time,intraoperative bleeding volume,weight of prostate tissue,postoperative urethral catheter removal and postoperative hospitalization time were statistically analyzed.The follow-up data such as preoperative and postoperative 3 months peak urinary flow rate(Qmax),residual urine volume(PVR)and International Prostate Symptom Score(IPSS)were analyzed.Results All the 31 patients were successfully operated.The average operative time was(65.80±17.50)min.The average intraoperative bleeding was(40.0±12.87)mL.The average weight of prostate gland extirpation was(32.0±3.84)g.The average postoperative time of ureter extraction was 3.0 d,and the average postoperative hospitalization time was 4.73 d.The Qmax(19.38±2.13)mL/s of patients at 3 months after operation was significantly higher than that of preoperative(6.81±2.42)mL/s,the difference was statistically significant(t=-19.28,P<0.001).The PVR(8.71±1.04)mL and IPSS(5.13±0.61)points of patients 3 months after surgery were significantly lower than preoperative PVR(225.58±22.37)mL and IPSS(23.0±2.76)points,the difference was statistically significant(t=53.92,P<0.001;t=15.710,P<0.001).There were no intraoperative bladder injury cases,no TUR syndrome,no intraoperative and postoperative severe bleeding requiring blood transfusion or no postoperative urethral stricture due to urinary incontinence.1 cases had dysuria after removal of the urethral catheter.The catheter was re-infested for 5 d and then the urethral catheter was removed.1 case was diagnosed as prostate cancer,and laparoscopic radical prostatectomy was performed 3 months after operation.Conclusion Transurethral Moses holmium laser prostatic enucleation is high safety,low risk,good efficacy,a wide range of indications and a short learning curve.The duration of hospitalization after the removal of the urethral catheter is short,and patients recover quickly.