改良式“U形”经尿道铥激光前列腺剜除术研究

Clinical study of modified U-shaped transurethral thulium laser prostatectomy

目的探讨改良式"U形"经尿道铥激光前列腺剜除术(modified transurethral thulium laser prostatectomy,TmLRP)治疗前列腺增生(benign prostatic hyperplasia,BPH)的临床疗效。方法收集我院采用TmLRP治疗的良性前列腺增生共计53例,将该治疗方法的疗效与经尿道等离子前列腺剜除术(transurethral plasma prostatectomy,PKEP)及传统经尿道等离子切除术(transurethral plasma prostatectomy,TUPR)对比,观察患者手术时间、拔尿管时间、出院时间、术中出血量、切除的前列腺质量,并比较3个月后国际前列腺症状评分(IPSS),生活质量评分(IPSS-QoL),最大尿流率(Qmax)的变化情况,统计其并发症,研究该方法的优越性。结果3组在年龄、前列腺体积、前列腺特异性抗原浓度(PSA)、最大尿流率(Qmax)、IPSS、IPSS-QoL差异无统计学意义(P>0.05)。在手术时间、出血量、术后拔尿管时间与住院时间、切除前列腺组织、术后3个月最大尿流率方面,TmLRP、PKEP组与TURP组相比差异均有统计学意义(P<0.01)。3组IPSS和IPSS-QoL均有显著改善(P<0.01)。PKEP组出现暂时性尿失禁的病例数更多,TmLEP、TURP组与PKEP相比差异有统计学意义(P<0.01)。结论TmLEP、PKEP和TURP在BPH的治疗中,PKEP组短暂性尿失禁较高,TURP住院时间及手术时间较长,出血量较多,切除的前列腺组织最少,最大尿流率改善最小,TmLEP组术后住院时间和拔管时间短,同时不需要抗凝治疗,3种术式比较,TmLEP更有优势。

ObjectiveTo explore the advantages of modified U-shaped transurethral thulium laser prostatectomy(TmLRP).Methods A total of 53 cases of benign prostatic hyperplasia treated by modified U-shaped TmLRP in our hospital were collected.The efficacy of this treatment was compared with that of transurethral plasmaprostatectomy(PKEP)and traditional transurethral plasma prostatectomy(TUPR).Operation time,extubationtime,discharge time,the amount of bleeding during operation and the quality of resected prostate were observed.Three months later,the changes of IPSS,IPSS-QoL,Qmax and the complications were compared.ResultsTherewas no significant difference in age,prostate volume,PSA,Qmax,IPSS and IPSS QOL among the three groups(P>0.05).In terms of operation time,bleeding volume,time of catheter removal and hospitalization after opera-tion,prostatectomy,and the maximum flow rate 3 months after operation,there was significant difference betweenTmLRP group,PKEP group and TURP group(P<0.01).IPSS and IPSS QOL in the three groups were all signifi-cantly improved(P<0.01).More cases of temporary urinary incontinence were found in PKEP group.There was sig-nificant difference between TmLEP and TURP group and PKEP group(P<0.01).ConclusionsIn treatment ofBPH,higher transient urinary incontinence is found in PKEP group,but in TURP group,there are longer hospital-ization time and operation time,more bleeding,fewest prostate tissue excision,minimum improvement of maxi-mum urinary flow rate,and in TmLEP group,there are shorter hospitalization time and extubation time after opera-tion,and no anticoagulation therapy is needed after the operation.Consequently,TmLEP had more advantages than the other two methods.