钬激光前列腺剜除术治疗大体积前列腺增生的疗效及安全性

The efficacy and safety of holmium laser enucleation of the prostate for large prostatic adenoma in patients with benign prostatic hyperplasia

目的探讨钬激光前列腺剜除术(HoLEP)治疗大体积(>80 mL)良性前列腺增生(BPH)的疗效和安全性。方法收集2017年10月至2018年12月在本院行HoLEP的128例大体积BPH患者的临床资料。记录围手术期指标如剜除时间、粉碎时间、获取前列腺组织标本质量、术后膀胱冲洗时间等。术后1、6、12个月时评估国际前列腺症状评分(IPSS)、生活质量(QOL)评分、残余尿量(PVR)、最大尿流率(Q_(max)),并与术前一般资料进行对比。结果所有患者的手术均顺利完成。获取前列腺组织标本质量为(89.70±24.03)g,血红蛋白丢失量为(10.07±6.83)g/L,剜除时间为(38.85±9.11)min,粉碎时间为(8.48±3.51)min,剜除效率为(2.31±0.30)g/min,粉碎效率为(11.46±3.29)g/min,术后膀胱冲洗时间为(1.08±0.29)d,尿管留置时间为(2.01±0.31)d,术后住院时间为(2.95±0.42)d。术后患者Q_(max)明显提高,IPSS、PVR、Q0L评分大幅度减低(P<0.001)。共发生并发症23例,其中压力性尿失禁8例,尿道狭窄1例,膀胱黏膜轻度损伤3例,泌尿道感染5例,拔管后尿潴留5例,输血1例,经对症治疗后均好转。结论HoLEP治疗大体积BPH疗效确切、安全可靠,值得进一步推广应用。应用Ho-LEP治疗大体积BPH,手术难度相对较大,对术者技术要求较高。术中精细谨慎操作,找对包膜层次、严密止血可提高手术安全性。

Objective To explore the efficacy and safety of HoLEP in the treatment of BPH with large volume(>80 mL),and summarize the experience of cure.Methods From October 2017 to December 2018,clinical data of 128 patients with large volume BPH who underwent HoLEP in our hospital were analyzed retrospectively.The perioperative parameters such as enucleation time,crush time,enucleate prostate weight,postoperative bladder irrigation time,indwelling catheter time,postoperative hospital stay time,hemoglobin loss value and complications were recorded.IPSS,QOL,PVR,Q_(max) and the incidence of complications were evaluated at 1 month,6 months and 1 year after surgery.The follow-up data were compared with the preoperative baseline data to assess the efficacy and safety of HoLEP in the treatment of large volume BPH.Results All patients were successfully operated.The resection weight of prostate was(89.70±24.03)g,the hemoglobin loss was(10.07±6.83)g/L,the enucleation time was(38.85±9.11)min,the crush time was(8.48±3.51)min,the enucleation efficiency was(2.31±0.30)g/min,the crush efficiency was(11.46±3.29)g/min,the postoperative bladder irrigation days were(1.08±0.29)days,the catheter indwelling days were(2.01±0.31)days,and the postoperative hospitalization days were(2.95±0.42)days.Compared with the baseline data,the postoperative Q_(max) increased considerably,IPSS,PVR and QOL decreased significantly(P<0.001).Complications occurred in 23 cases,including 8 cases of stress urinary incontinence,1 case of urethral stricture,3 cases of mild damage to bladder mucosa,5 cases of urinary tract infection,5 cases of urinary retention after catheter removal,and 1 case of blood transfusion,all of which improved after symptomatic treatment.Conclusions HoLEP is safe,effective and reliable in treating large volume BPH,which is worthy of further promotion and application.The application of HoLEP in the treatment of large-volume BPH is relatively difficult,and requires higher technical for the operator.The safety of operation can be improved by careful perform,finding the right capsule layer and effective hemostasis.