HoLEP与TUPKP治疗不同体积良性前列腺增生的疗效及安全性研究

Efficacy and safety of HoLEP and TUPKP in the treatment of patients with various volumesbenign prostatic hyperplasia

目的观察钬激光前列腺剜除术(HoLEP)与经尿道前列腺等离子双极电切术(TUPKP)治疗不同体积良性前列腺增生(BPH)患者的疗效及安全性。方法回顾性分析2017年1月至2019年1月重庆医科大学附属第一医院泌尿外科收治的239例BPH患者,其中147例行HoLEP(HoLEP组),92例行TUPKP(TUPKP组)。根据前列腺体积大小将以上两组患者再分别分为3个亚组(Group 1:<30 mL;Group 2:30~80 mL;Group 3:>80 mL)。分别比较HoLEP组与TUPKP组相对应亚组间的基本资料、围术期资料及术后随访指标。结果HoLEP各亚组切除标本质量、组织剜除(切除)率明显高于TUPKP组(P<0.05),血红蛋白下降值、膀胱冲洗时间、导尿管留置时间、术后住院时间明显少于TUPKP组(P<0.05),HoLEP与TUPKP各亚组手术时间无明显差异(P>0.05)。HoLEP组术后尿失禁发生率明显高于TUPKP组(P<0.05),两组输血率、尿道狭窄率、膀胱颈挛缩率无明显差异(P>0.05);术后随访国际前列腺症状评分(IPSS)、生活质量评分(QoL评分)、最大尿流率(Qmax)、排尿量、排尿时间、残余尿(PVR)在HoLEP与TUPKP各亚组间无明显差异(P>0.05),术后随访6个月各亚组IPSS及QoL评分较术前明显降低(P<0.01)。结论HoLEP和TUPKP治疗各种体积大小的前列腺增生均安全有效,HoLEP较TUPKP出血更少,组织剜除更彻底,更利于患者快速康复。

Objective To investigate the clinical efficacy and safety of holmium laser enucleation of the prostate(HoLEP)and bipolar transurethral plasmakinetic prostatectomy(TUPKP)in the treatment of patients with various volumes of benign prostatic hyperplasia(BPH).Methods A retrospective analysis of 239 patients with BPH admitted to the First Affiliated Hospital of Chongqing Medical University from January 2017 to January 2019 was performed.Among them,147 patients received HoLEP(the HoLEP group),and 92 patients received TUPKP(the TUPKP group).According to the prostate gland volume,the above two groups of patients were divided into three subgroups(group 1:<30 mL;group 2:30-80 mL;group 3:>80 mL).The basic information,perioperative data and postoperative follow-up indicators between the corresponding HoLEP subgroups and TUPKP subgroups were compared.Results Compared with the TUPKP subgroups,the weight of excised specimen and rate of enucleated(resected)tissue in the HoLEP subgroups were significantly increased(P<0.05),while the decreased level of hemoglobin,bladder irrigation time,indwelling time of catheter and postoperative hospital stay were significantly decreased(P<0.05).No significant difference was found in the operating time between the corresponding HoLEP subgroups and TUPKP subgroups(P>0.05).The incidence of Incidence of postoperative urinary incontinence in the HoLEP group was significantly higher than that in the TUPKP group(P<0.05),while no significant difference was found in blood transfusion rate,urethral stricture rate and bladder neck contracture rate between the two groups(P>0.05).There was no statistically significant difference in the postoperative follow-up international prostate symptom score(IPSS),quality of life score(QoL score),maximum urinary flow rate(Qmax),urination volume,urination time and post-voiding residual(PVR)between the corresponding HoLEP subgroups and TUPKP subgroups(P>0.05).After 6 months of follow-up,the IPSS and QoL scores of each subgroup were significantly lower than those before surgery(P<0.01).Conclusion HoLEP and TUPKP are safe and effective for the treatment of BPH of various sizes.Compared with TUPKP,HoLEP has less bleeding,more thorough tissue removal,which is more conducive to the rapid recovery of patients.