钬激光剜除术同期治疗非肌层浸润性膀胱癌合并良性前列腺增生的临床观察

A clinical study of holmium laser enucleation in the treatment of non-muscle invasive bladder cancer complicated with benign prostatic hyperplasia

目的总结钬激光剜除术同期治疗非肌层浸润性膀胱癌合并良性前列腺增生的临床经验。方法回顾性分析采用钬激光剜除术同期治疗浅表性膀胱癌并良性前列腺增生38例患者的临床资料,比较术前与术后3、6个月国际前列腺症状评分、最大尿流率、生活质量评分及膀胱残留尿量,同时统计手术时间及术后并发症发生和肿瘤复发等情况。结果所有患者手术均获成功,手术时间为91~202 min,平均105 min,无膀胱穿孔等并发症发生。术后7 d拔除尿管,发生暂时性尿失禁4例,继发性出血2例。术后3个月,无膀胱肿瘤复发病例,国际前列腺症状评分由术前(26.31±1.92)分降至术后(19.36±1.22)分(P>0.05),生活质量评分由术前(5.02±0.79)分降至术后(3.56±1.16)分(P>0.05),最大尿流率由术前(4.68±2.89)mL/s升至术后(14.91±2.18)mL/s(P<0.05),膀胱残余尿量由术前(70.02±19.91)mL降至术后(20.11±12.38)mL(P<0.05);术后6个月,1例患者膀胱肿瘤复发,国际前列腺症状评分降至(11.36±1.27)分,生活质量评分降至(1.26±1.08)分,最大尿流率为(14.98±3.24)mL/s,膀胱残余尿量为(19.17±9.02)mL,与术前相比均有统计学意义(P均<0.05)。术后12个月,共6例患者肿瘤复发,无尿道狭窄等远期并发症发生。结论钬激光剜除术是同期治疗浅表性膀胱癌并良性前列腺增生的一种安全、有效的方法。

Objective To summarize the clinical experience of holmium laser enucleation in the treatment of non-muscle invasive bladder cancer(NMIBC)complicated with benign prostatic hyperplasia(BPH).Methods The clinical data of 38 NMIBC patients with BPH treated with holmium laser enucleation were retrospectively analyzed.The international prostate symptom score(IPSS),maximum flow rate(Qmax),quality of life(QoL)score and residual urine volume(RUV)were compared before operation and 3 and 6 months after operation.The operation time,postoperative complications and recurrence were recorded.Results All operations were successful.The operation time was 91-202 min,average 105 min.No complications such as bladder perforation occurred.Urinary incontinence occurred in 4 cases and secondary bleeding in 2 cases 7 days after operation.No recurrence was observed 3 months after operation.The IPSS decreased from(26.31±1.92)before operation to(19.36±1.22)after operation(P>0.05),QoL score decreased from(5.02±0.79)to(3.56±1.16)(P>0.05),Qmax increased from(4.68±2.89)mL/s to(14.91±2.18)mL/s(P<0.05),and RUV decreased from(70.02±19.91)mL to(20.11±12.38)mL(P<0.05).Six months after operation,IPSS decreased from(26.31±1.92)to(11.36±1.27),quality of life(QoL)score decreased from(5.02±0.79)to(1.26±1.08),Qmax increased from(4.68±2.89)mL/s to(14.98±3.24)mL/s,and bladder post void residual(PVR)decreased from(70.02±19.91)mL to(19.17±9.02)mL(all P<0.05).No recurrence or long-term complications such as urethral stricture occurred 12 months after operation.Conclusion Holmium laser enucleation is a safe and effective method for the treatment of NMIBC with BPH.