逆行HoLEP对大体积前列腺增生患者术后康复进程的影响

Effect of retrograde HoLEP on the postoperative rehabilitation of patients with massive prostatic hyperplasia

目的研究逆行经尿道前列腺钬激光剜除术(HoLEP)对大体积前列腺增生患者术后康复进程的影响。方法选取2018年2月至2019年2月陕西省核工业二一五医院诊治的96例前列腺增生患者作为研究对象。以随机数表法分为观察组(n=48)与对照组(n=48)。观察组以逆行HoLEP治疗,对照组行传统HoLEP治疗。比较两组患者围术期相关临床指标(出血量、膀胱冲洗时间、导管留置时间、术后下床时间、住院时间、切除组织重量)及术后并发症发生情况,另外比较两组患者治疗前后残余尿量(PVR)、最大尿流率(Qmax)、最大尿流率时的逼尿肌压力(Pdet.max)、膀胱出口梗阻指数(BOOI)、前列腺体积、前列腺特异性抗原(PSA)及国际前列腺症状评分表(IPSS)、生活质量指数(QOL)评分差异。结果观察组患者出血量少于对照组患者,差异具有统计学意义(P<0.05);两组患者膀胱冲洗时间、导管留置时间、术后下床时间、住院时间、切除组织重量各项指标比较,差异无统计学意义(P>0.05)。组间比较,两组患者治疗前(后)PVR、Qmax、Pdet.max、BOOI、前列腺体积、PSA各项指标比较,差异无统计学意义(P>0.05);组内比较,两组患者治疗后PVR、Pdet.max、BOOI、前列腺体积、PSA低于治疗前,差异具有统计学意义(P<0.05);组内比较,两组患者治疗后Qmax高于治疗前,差异具有统计学意义(P<0.05)。组间比较,两组患者治疗前(后)IPSS、QOL评分比较,差异无统计学意义(P>0.05);组内比较,两组患者治疗后IPSS、QOL评分低于治疗前,差异具有统计学意义(P<0.05)。观察组患者术后并发症总发生率(6.25%)低于对照组患者(20.83%),差异具有统计学意义(P<0.05)。结论逆行HoLEP用于大体积前列腺增生可缓解患者临床症状,提高生活质量,且与传统HoLEP相比逆行HoLEP具有出血量少,术后并发症发生率低的优势,有利于患者术后恢复,值得临床推广。

Objective To investigate the effect of retrograde transurethral holmium laser enucleation of the prostate(HoLEP)on the postoperative rehabilitation of patients with massive prostatic hyperplasia.Methods A total of 96 patients with prostatic hyperplasia diagnosed and treated in our hospital from February 2018 to February 2019 were selected as the research objects,and were randomly divided into observation group and control group,with 48 patients in each group.The observation group received retrograde HoLEP treatment,and the control group received traditional HoLEP treatment.The perioperative clinical indicators(blood loss,bladder douche time,catheter indwelling time,postoperative bed time,length of hospital stay,removing tissue weight)and incidences of postoperative complications were compared between the two groups.In addition,the residual urine volume(PVR),maximum urinary flow rate(Qmax),maximum urinary flow rate when the detrusor pressure(Pdet.Max),bladder outlet obstruction index(BOOI),prostate specific antigen(PSA),prostate volume and international prostate symptom scale(IPSS),the index of quality of life(QOL)scores were compared before and after treatment between the two groups.Results The amount of blood loss in the observation group was less than that in the control group,with statistically significant differences(P<0.05).There was no significant difference in bladder irrigation time,catheter indwelling time,time to get out of bed after operation,hospital stay and resection tissue weight between the two groups(P>0.05).There was no significant difference in PVR,Qmax,Pdet.max,BOOI,prostate volume and PSA between the two groups before/after treatment(P>0.05).After treatment,the PVR,Pdet.max,BOOI,prostate volume and PSA of the two groups were significantly lower than those before treatment,and the difference was statistically significant(P<0.05).The Qmax of the two groups after treatment was significantly higher than that before treatment,with statistically significant differences(P<0.05).There was no significant difference in IPSS and QOL scores between the two groups before/after treatment(P>0.05).The IPSS and QOL scores of the two groups after treatment were significantly lower than those before treatment,with statistically significant differences(P<0.05).The total incidence of complications in the observation group(6.25%)was lower than that in the control group(20.83%),with statistically significant differences(P<0.05).Conclusions Retrograde HoLEP can alleviate the clinical symptoms and improve the quality of life of patients with large volume prostatic hyperplasia.In addition,compared with traditional HoLEP,retrograde HoLEP has the advantages of less blood loss and lower postoperative complication rate,which is conducive to postoperative recovery of patients and worthy of clinical promotion.