经尿道前列腺钬激光剜除术中整叶法与分叶法治疗良性前列腺增生的疗效

Efficacy of whole leaf method and divided leaf method in transurethral holmium laser enucleation of prostate for benign prostatic hyperplasia

目的比较经尿道前列腺钬激光剜除术(HoLEP)中整叶法和分叶法治疗良性前列腺增生(BPH)的疗效。方法回顾性分析行HoLEP治疗的150例男性BPH患者临床资料,根据手术方式分为两组,其中整叶法组46例,分叶法组104例。比较两组手术时间、术后血红蛋白、切除组织体积、导尿管留置时间、并发症及随访情况。结果分叶法组患者手术时间较整叶法组短(P<0.05)。两组术后血红蛋白、切除组织体积、导尿管留置时间等无统计学差异(P>0.05)。整叶法组患者术后尿失禁发生率及总并发症发生率高于分叶法组(P<0.05)。与术前比较,两组患者术后1个月最大尿流率、国际前列腺症状评分(IPSS)、生活质量评分(QOL评分)和残余尿量均改善(P<0.05),而两组患者手术前后性功能评分量表(IIEF-5)评分均无明显改善(P>0.05)。术后1个月,两组患者最大尿流率、IPSS、QOL评分、残余尿量、IIEF-5评分比较无统计学差异(P>0.05)。结论整叶法与分叶法均可安全、有效治疗BPH,在具有相同手术效果的前提下,分叶法较整叶法操作时间更短,对老年患者更安全。

Objective To compare the therapeutic effects of transurethral holmium laser enucleation of the prostate(HoLEP)by whole leaf method and divided leaf method in the treatment of benign prostatic hyperplasia(BPH).Methods The clinical data of 150 male BPH patients treated with HoLEP were retrospectively analyzed.According to the surgical method,the patients were divided into two groups of A(46 cases,treated with whole leaf method)and B(104 cases,treated with divided leaf method).The operation time,postoperative hemoglobin,volume of excised tissues,indwelling catheter time,complications and follow-up were compared between the two groups.ResultsThe operation time of group B was shorter than that of group A(P<0.05).There were no significant differences in postoperative hemoglobin,volume of excised tissues,and catheterization time between the two groups(P>0.05).The incidences of postoperative urinary incontinence and total complications in group A were higher than those in group B(P<0.05).Compared with before operation,the maximum urinary flow rate,international prostate symptom score(IPSS),quality of life score(QOL score),and residual urine volume in two groups in one month after operation were all improved(P<0.05),while there was no significant improvement in sexual function score scale(IIEF-5)score before and after surgery(P>0.05).One month after operation,there were no significant differences in the maximum urinary flow rate,IPSS,QOL score,residual urine volume and IIEF-5 score between the two groups(P>0.05).Conclusion Both of whole leaf method and divided leaf method can safely and effectively treat BPH.Under the premise of having the same surgical effect,HoLEP with divided leaf method has shorter operation time than whole leaf method and is safer for the elderly patients with BPH.