前列腺穿刺术后早期行TURP与HoLEP的安全性及疗效对比

Comparison of safety and efficacy between early transurethral resection of prostate and transurethral holmium laser enucleation of prostate after prostate paracentesis

目的比较前列腺穿刺术后早期行经尿道前列腺电切术(TURP)与经尿道钬激光前列腺剜除术(HoLEP)的安全性及疗效。方法回顾性分析2019年9月至2021年6月于该院行前列腺穿刺术后早期再次手术的86例良性前列腺增生(BPH)患者资料,根据其穿刺后采用的手术方式将患者分为两组,TURP组44例,HoLEP组42例,收集患者术前临床资料、术中资料及并发症情况,术后第3个月复查随访结果,比较两种手术方式的安全性和疗效。结果两组患者术前临床资料无明显差异(P>0.05);HoLEP组手术时间、血红蛋白(Hb)下降水平、术后膀胱持续冲洗时间、留置尿管时间、住院时间均少于TURP组,切除前列腺组织重量高于TURP组,差异均有统计学意义(P<0.05);在并发症方面,HoLEP组术后短暂性尿失禁发生率明显高于TURP组(P<0.05),稀释性低钠血症、术后再次导尿及术中或术后输血发生率均低于TURP组,差异无统计学意义(P>0.05);术后第3个月随访显示,两组国际前列腺症状评分(IPSS)、生存质量(QOL)评分、最大尿流率(Qmax)及膀胱残余尿量(PVR)无明显差异(P>0.05),均较术前明显改善(P<0.05),HoLEP组术后血清前列腺特异性抗原(PSA)水平明显低于TURP组(P<0.05)。结论前列腺穿刺术后早期行HoLEP与TURP的疗效接近,但HoLEP较TURP在手术效率、安全性上更有优势,且降低血清PSA水平更明显。

Objective To compare the safety and efficacy between early transurethral resection of prostate(TURP)and HoLEP(holmium laser enucleation of prostate)after prostate paracentesis.Methods The clinical data of 86 cases of patients with benign prostate hyperplasia(BPH)undergoing early reoperation after prostate paracentesis in this hospital from September 2019 to June 2021 were retrospectively analyzed.According to the receiving operation mode after prostate paracentesis,the patients were divided into the two groups:the TURP group(n=44)and HoLEP group(n=42).The preoperative clinical data,intraoperative data and complications of the patients were collected.The follow-up results were re-examined at postoperative 3 months.The safety and effects were compared between the two operation modes.Results There was no significant difference in preoperative clinical data between the two groups(P>0.05).The operative time,level of hemoglobin(Hb)decrease,postoperative bladder continuous irrigation time,postoperative indwelling urinary catheter time and hospital stay in the HoLEP group were less than those in the TURP group,and the weight of removed prostate tissue was higher than that in the TURP group(P<0.05).In the aspect of complications,the incidence rate of postoperative transient urinary incontinence in the HoLEP group was significantly higher than that in the TURP group(P<0.05).But the incidence rates of dilution hyponatremia,postoperative urinary re-catheterization,and intraoperative or postoperative blood transfusion in the HoLEP group were lower than those in the TURP group,but no statistically significant difference was found(P>0.05).The postoperative 3-month follow-up results showed that there were no significant differences in scores of international prostate symptom score(IPSS)and quality of life(QOL),maximum urinary flow rate(Qmax)and post void residual urine volum(PVR)between the two groups(P>0.05),but which were significantly improved compared with those before operation(P<0.05).The postoperative serum prostate specific antigen(PSA)level in the HoLEP group was significantly lower than that in the TURP group(P<0.05).Conclusion Early TURP and HoLEP after prostate paracentesis has similar effect,but HoLEP has more advantages than TURP in terms of operation efficiency and safety,moreover,which is more effective in decreasing serum PSA.