改良钬激光前列腺剜除术与经尿道前列腺电切术治疗大体积良性前列腺增生患者的效果比较

Modified holmium laser enucleation of the prostate versus transurethral resection of prostate in treatment patients with large volume prostatic hyperplasia

目的比较改良钬激光前列腺剜除术(HOLEP)与经尿道前列腺电切术(TURP)治疗大体积(体积大于80 mL)良性前列腺增生(BPH)患者的疗效。方法将60例大体积BPH患者随机分为HOLEP组(n=28)和TURP组(n=32)。比较2组手术前后相关指标的变化。结果2组术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Q max)均较术前显著改善,HOLEP组国际勃起功能问卷的勃起功能专项评分(IIFE-5)也显著改善(P<0.05),但2组术后上述指标无显著差异(P>0.05)。HOLEP组切除组织质量为(41.98±8.16)g,显著多于TURP组的(31.38±2.95)g(P<0.05)。HOLEP组血红蛋白丢失量、膀胱冲洗时间、留置导尿管时间、住院时间等指标显著优于TURP组(P<0.05),但2组手术时间无显著差异(P>0.05)。HOLEP组并发症发生率为10.71%,TURP组并发症发生率为43.75%,2组差异有统计学意义(P<0.05)。结论治疗大体积BPH患者时,HOLEP术具有出血量更小、组织切除量更多、留置导尿管及膀胱冲洗时间更短、术后并发症更少等优势,可避免控制排尿功能的肌肉受损。

Objective To compare effect of modified holmium laser enucleation of the prostate(HOLEP)and transurethral resection of the prostate(TURP)in the treatment of large volume(more than 80 mL)benign prostatic hyperplasia(BPH).Methods A total of 60 patients with large volume BPH were randomly divided into HOLEP group(n=28)and TURP group(n=32).The changes of related indicators preoperation and postoperation were compared.Results Compared with treatment before,the International Prostate Symptom Score(IPSS),Quality of Life Score(QOL),post-void residual(PVR)and maximum flow rate(Q max)after operation were significantly improved in the two groups,and International Index of Erectile Function(IIFE-5)score in the HOLEP group was significantly improved(P<0.05),but no significant between-group differences were found in above indicators(P>0.05).The mass of excised tissue in the HOLEP group was(41.98±8.16)g,which was significantly more than(31.38±2.95)g of the TURP group(P<0.05).The amount of hemoglobin loss,indwelling catheter time,bladder irrigation time and the postoperative hospital stay were significantly better than those of the TURP group(P<0.05),but no difference in operative time in two group was found(P>0.05).The incidence of postoperative complications in the HOLEP group was 10.71%,which was significantly lower than 43.75%in the TURP group(P<0.05).Conclusion Compared with TURP,HOLEP has the advantages of less bleeding,larger volume of excised tissue,shorter indwelling catheter and bladder irrigation time,and less postoperative complications,and it can better protect muscles that control urination from injury.