1470 nm激光“旋切法”前列腺剜除术在预防术后尿失禁中的应用

“Spin cutting”technique in 1470 nm laseRenucleation of the prostate to prevent postoperative urinary incontinence

目的:探讨1470 nm激光“旋切法”前列腺剜除术(TUEP)在预防术后短期尿失禁中的应用效果及手术技巧。方法:将120例前列腺增生患者随机分为两组,每组60例,分别行1470 nm激光“旋切法”TUEP术与传统TUEP术。60例“旋切法”TUEP术,另60例使用传统TUEP术。比较两组患者手术时间、术后尿失禁发生情况及恢复时间、Hb下降值、术中出血量、术后留置尿管时间、术后住院时间、国际前列腺症状评分(IPSS)、生活质量评分(QOL)和最大尿流率(Qmax)。结果:手术均顺利完成,术后病理为良性前列腺增生。治疗前后IPSS、Qmax及QOL两组间比较差异无统计学意义(P>0.05)。两组患者在手术时间、术中出血量、Hb下降值、术后住院时间、术后留置尿管时间上比较差异也无统计学意义(P>0.05)。但两组术后拔除导尿管24 h暂时性尿失禁发生率比较差异有统计学意义(χ2=14.579,P=0.000)。采用“旋切法”TUEP术后无暂时尿失禁。传统TUEP术后暂时性尿失禁13例,通过盆底肌功能训练,8例在术后2周时痊愈,1例在1月时痊愈,2例在3个月痊愈,1例在6个月时痊愈,1例术后18个月仍有压力性尿失禁。2组均无包膜穿孔、大出血及术后膀胱颈狭窄发生。结论:“旋切法”TUEP术疗效确切,并能有效预防术后短期尿失禁的发生。

Objective:To discuss the“spin cutting”technique of transurethral enucleation of the prostate(TUEP)using 1470 nm diode laseRin prevention of postoperative urinary incontinence.Methods:120 patients with prostatic hyperplasia were equally randomized into two groups.Patients in one group underwent TUEP with 1470 nm diode laseRby“spin cutting”,and those in anotheRgroup were treated with conventional TUEP.The two groups were compared regarding operative time,postoperative urinary incontinence and recovery time,dropped hemoglobin level,intraoperative blood loss,length of catheteRindwelling afteRoperation,postoperative hospital stay,scoring on International Prostate Symptom Scale(IPSS),Quality of Life(QOL)and maximum urinary flow rate(Qmax).Results:Surgery was successfully completed in both groups,and postoperative pathology revealed that all cases were benign prostatic hyperplasia.The two groups were not significantly different in IPSS,Qmax and QOL before and afteRsurgery as well as operative time,intraoperative blood loss,dropped hemoglobin level,postoperative hospital stay and indwelling catheter(all P>0.05),yet the difference was significant in the incidence of temporary urinary incontinence within 24 h afteRremoval of the catheter(χ2=14.579,P=0.000).Temporary urinary incontinence was free in patients treated with“spin cutting”technique,yet occurred in 13 patients by conventional TUEP,who were managed by pelvic flooRmuscle function training.Two patients recovered at week 2,one by 1 month,2 by 3 months,one by 6 months following surgery.Urinary incontinence persisted till 18 months in anotheRpatient.No capsule perforation,massive hemorrhage oRpostoperative bladdeRneck stenosis occurred in eitheRgroup.Conclusion:“Spin cutting”technique may effectively prevent short-term postoperative urinary incontinence in patients undergoing TUEP using 1470 nm diode laser.