内镜下不同术式的前列腺剜除术疗效对比

Clinical comparative analysis of the different techniques of endoscopic prostate enucleation

目的探讨经尿道单极前列腺剜除术与激光(钬激光、铥激光)前列腺剜除术疗效。方法回顾性分析2018年1月~2020年6月期间南充市中心医院接受不同术式治疗的良性前列腺增生患者693例。将行钬激光前列腺剜除术(HoLEP)者设为HoLEP组(489例),行单极前列腺剜除术者设为单极前列腺剜除术组(51例),行铥激光前列腺剜除术(ThuLEP)者设为ThuLEP组(153例)。比较3组术式手术时间、住院时间、术后疗效、术后并发症及术后功能参数等临床指标。结果HoLEP组及ThuLEP组手术时间、住院时间、留置尿管时间均短于单极前列腺剜除术组(P<0.05)。HoLEP组及ThuLEP组术后出血、再次留置尿管率也低于单极前列腺剜除组(P<0.05)。3种术式切除前列腺重量、术后短暂性尿失禁及改善患者前列腺症状评分(I-PSS)、生活质量(QoL)、最大尿流率(Qmax)、残余尿量(PVR)方面差异无统计学意义(P>0.05)。结论3种术式治疗前列腺增生疗效相当,但HoLEP及ThuLEP可缩短手术时间及住院时间,减少术后出血及再次留置尿管率,安全性更高。

Objective To compare monopolar and laser enucleation(thulium,holmium)of prostate hyperplasia.Methods 693 patients with benign prostate hyperplasia(BPH)who were enrolled and treated in Nanchong Centrqal Hospital from January 2018 to June 2020 were selected as research objects.According to different treatment methods,they were divided into three groups.489 patients underwent holmium enucleation(HoLEP),51 monopolar enucleation,153 patients underwent thulium enucleation(ThuLEP).The operation time,hospital stay,postoperative conditions,postoperative complications and postoperative functional parameters of the three groups were compared.Results Compared with the patients treated by monopolar enucleation,those in the HoLEP and ThuLEP group showed a significantly shorter operation time(P<0.05),shorter hospital stay(P<0.05),shorter time of catheterization(P<0.05).In postoperative complications,compared with the patients treated by monopolar enucleation,those in the HoLEP and ThuLEP group showed a significantly less bleeding(P<0.05),repeat catheterization(P<0.05).But there was no significant difference in the volume of the resected prostate,short-term stress urinary incontinence,I-PSS,QoL,Qmax,and PVR(P>0.05).Conclusion HoLEP,monopolar enucleation,and ThuLEP have similar effective in the treatment of benign prostatic hyperplasia.However,HoLEP and ThuLEP can shorten the operation time and hospital stay,reduce postoperative bleeding and the rate of reindwelling catheter,which is safer.