绿激光直出式剜除和选择性汽化治疗良性前列腺增生症患者的随机对照研究

Green light top-firing sharp enucleation of prostate versus photoselective vaporisation of prostate for benign prostatic hyperplasia:a randomized controlled trial

目的对比经尿道直出光纤绿激光前列腺锐性剜除术(green light top-firing,sharp enucleation of the prostate,GTSEP)和绿激光选择性光汽化术(photoselective vaporisation of the prostate,PVP)治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)患者的有效性和安全性。方法选取2018年6月至2019年4月在本院诊治的154例BPH患者,按随机数字表法分为两组,每组77例,分别行GTSEP和PVP。评估两组患者术前一般情况,记录并比较术后第1个月和第6个月国际前列腺症状评分(IPSS)、生活质量评分(QoLs)、残余尿(PVR)、最大尿流率(Qmax)、前列腺体积(PV)、前列腺特异抗原(PSA)及并发症等。结果两组各有74例患者完成了随访。两组患者术前基本资料差异无统计学意义。术后1、6个月,两组患者下尿路症状均较术前明显改善,但IPSS、QoLs、PVR、Qmax、PSA差异无统计学意义。GTSEP组手术时间明显短于PVP组(41.0±16.4 vs 50.1±18.1 min,P=0.001),术后6个月GTSEP组前列腺体积小于PVP组(22.4±2.4 vs 23.3±1.9 mL,P=0.011)。两组术中和术后近期并发症差异无统计学意义。结论GTSEP与PVP治疗BPH均能获得较好的效果,GTSEP能更大程度去除增生的腺体组织,手术效率优于PVP。

Objective To compare the efficacy and safety of a novel procedure,green light top-firing,sharp enucleation of the prostate(GTSEP)and the traditional procedure,photoselective vaporisation of the prostate(PVP)in the treatment of benign prostatic hyperplasia(BPH).Methods A total of 154 patients diagnosed with BPH admitted in our hospital from June 2018 to April 2019 were recruited in this study,and then randomly divided into GTSEP group(n=77)and PVP group(n=77).All patients were assessed preoperatively and followed at 1 and 6 month postoperatively.International prostate symptom score(IPSS),quality of life score(QoLs),post-void residual urine(PVR),maximum urine flow rate(Qmax),prostate volume(PV),prostate-specific antigen(PSA)and complications were recorded and compared between the 2 groups.Results There were 74 patients in each group completing the follow-up.No significant differences were found in baseline data between the 2 groups.At 1 and 6 months after surgery,both groups had their lower urinary tract symptoms significantly improved,but there were no significant differences in IPSS,QoLs,PVR,Qmax and PSA between the 2 groups.However,the GTSEP group had significantly shorter operation time(41.0±16.4 vs 50.1±18.1 min,P=0.001),and smaller prostate volume at 6 months after surgery(22.4±2.4 vs 23.3±1.9 mL,P=0.011)when compared with the PVP group.No notable differences were seen in the incidence of intraoperative and postoperative complications between the 2 groups.Conclusion Both GTSEP and PVP achieve good efficacy and safety in BPH treatment.GTSEP can remove larger hyperplastic tissue than PVP,and is superior to PVP in operation efficacy.