HoLEP治疗小体积良性前列腺增生合并重度下尿路症状临床疗效观察

Clinical efficiency of holmium laser enucleation of the prostate for small-volume benign prostatic hyperplasia with severe LUTS

目的:探讨钬激光前列腺剜除术治疗小体积良性前列腺增生合并重度下尿路症状(LUTS)的安全性和有效性。方法:回顾性分析2017年1月至2018年12月收治的82例小体积良性前列腺增生患者的病例资料。年龄52~84(65.5±7.6)岁,经直肠超声检查前列腺体积<40 ml。IPSS评分为20~32(24.8±4.6)分。QoL为4~6(5.2±0.8)分。Qmax为1~14(7.6±3.7)ml/s。PSA为0.3~6.2(1.8±1.4)μg/L。结果:本组82例手术均顺利完成,总手术时间24~36(30.2±5.0)min;剜除时间15~30(26.7±5.6)min;粉碎时间1~5.5(3.5±1.1)min。取出腺体湿重12.6~30.1(20.3±4.9)g。术后持续膀胱冲洗时间为0~6(3.5±1.9)h;冲洗液用量为0~6(3.0±1.7)L;留置导尿时间12~48(24.8±9.7)h。69例(84.1%)患者术后组织病理提示中重度淋巴细胞浸润。术后1、6个月随访IPSS、QoL、Qmax和PSA等指标,均较术前有明显改善,具有统计学意义(P<0.05)。随访至今,无因尿道狭窄出现再次手术的患者。结论:钬激光剜除术治疗合并重度LUTS的小体积良性前列腺增生安全且有效,对于此类患者充分术前评估后可考虑手术治疗。

Objective:To evaluate the safety and clinical efficiency of holmium laser enucleation of the prostate(HoLEP)in the treatment of small-volume BPH(SBPH)complicated by severe lower urinary tract symptoms(LUTS).Methods:We retrospectively analyzed the clinical data on 82 cases of SBPH with severe LUTS treated by HoLEP from January 2017 to December 2018.The patients were aged(65.5±7.6)years,with a mean prostate volume of<40 ml,a total IPSS of 24.8±4.6,a QOL score of 5.2±0.8,the maximum urinary flow rate(Qmax)of(7.6±3.7)ml/s,and a mean PSA level of(1.8±1.4)μg/L.Results:All the operations were successfully completed,the mean operation time averaging(30.2±5.0)min,enucleation time(26.7±5.6)min and comminution time(3.5±1.1)min,and the enucleated tissue weighing(20.3±4.9)g.After surgery,the bladders were irrigated for(3.5±1.9)h,with(3.0±1.7)L of rinse solution,and catheterization lasted(24.8±9.7)h.Histopathology revealed moderate or severe lymphocytic infiltration in 69 cases(84.1%).At 6 months after operation,significant improvement was observed in the IPSS,QOL,Qmax and PSA level compared with the baseline(P<0.05).To date,no urethral stricture-related reoperation was ever necessitated.Conclusion:HoLEP is safe and effective for the treatment of SBPH complicated by severe LUTS and can be employed after adequate preoperative evaluation of the patient.