绿激光汽化治疗大体积前列腺增生的长期随访

Long-term follow-up of greenlight laser vaporization for large prostate

目的对比接受经尿道绿激光汽化(PVP)和耻骨上前列腺切除(OP)手术的体积大于80 mL前列腺增生患者的长期排尿功能。方法回顾性收集2016年8月至2018年6月147例大体积前列腺增生的患者资料,根据手术方式分为PVP组(85例)和OP组(62例),对比两组术前情况、围手术期情况和远期排尿功能情况,分析远期排尿功能的影响因素。结果随访147名患者,平均32个月,PVP组85名,OP组62名。尽管PVP组术前应用抗凝药物患者比OP组多(P<0.05),但其术后血红蛋白降低比OP组少(P<0.05),需输血者比OP组少(P<0.05)。术后PVP组比OP组国际前列腺症状评分(IPSS)高(P<0.05),前列腺残余体积大(P<0.05),术后最大尿流率低(P<0.05)。前列腺残余体积是术后IPSS的预测因素,模型:IPSS评分=(-14.16+0.42)×前列腺残余体积(R=0.89,sd=0.87,P=0.000)。结论PVP治疗大体积前列腺增生比较安全,远期疗效满意,但远期效果仍比OP稍差。PVP术中若尽量实现腺瘤的完全汽化,可以改善术后IPSS评分。对服用抗凝药物的患者,PVP是一种较好的替代方案。

【Objective】To compare the long-term urination function of patients with prostate volume larger than 80 mL treated by greenlight laser photoselective vaporisation of the prostate(PVP)and open prostatectomy(OP).【Methods】The data of patients admitted to the groups from August 2016 to June 2018 were collected retrospectively.According to the approach of surgery,patients were divided into PVP group(n=85)and OP group(n=62).Preoperative situation,perioperative situation,long-term urination function of the two groups were compared and the predictors of long-term function were analyzed.【Results】Totally 147 patients were followed up for an average of 32 months,including 85 cases in the PVP group and 62 cases in the OP group.Although more patients in the PVP group received anticoagulant drugs before surgery than in the OP group(P<0.05),the postoperative hemoglobin decreased less(P=0.05)and fewer patients needed blood transfusion(P<0.05).Long-term follow-up indicated that IPSS score in the PVP group was higher(P<0.05),the residual prostate volume was larger(P<0.05),and the postoperative maximum urine flow rate was lower(P<0.05)than that in the OP group.Residual prostate volume was a predictor of postoperative IPSS,and the model IPSS score=(-14.16+0.42)*residual prostate volume(R=0.89,sd=0.87,P=0.000).【Conclusion】PVP is safe in the treatment of large prostatic hyperplasia and has satisfactory long-term efficacy,although it is still slightly worse than OP.The complete vaporization of adenoma in PVP can improve the postoperative IPSS score.PVP is a good alternative for patients taking anticoagulants.