经尿道钬激光剜除术治疗BPH的临床效果及对fPSA、VEGF与性生活质量的影响

Clinical effect of Holmium laser enucleation of the prostate for the treatment of BPH and its effect on fPSA,VEGF and sexual life quality

目的研究经尿道钬激光剜除术(HoLEP)治疗良性前列腺增生(BPH)及对游离前列腺特异性抗原(fPSA)、血管内皮生长因子(VEGF)与性生活质量的影响。方法前瞻性选择2019年3月至2021年3月于沧州市人民医院泌尿外科治疗的BPH患者120例,依据随机数字表法将其分为HoLEP组与TURP组,每组各60例。HoLEP组行HoLEP,TURP组行经尿道前列腺电切术(TURP)。观察两组围手术期指标,术前及术后7 d血清fPSA、VEGF水平,术前及术后6个月前列腺增生情况及性生活质量,术后并发症。结果HoLEP组术中出血量、手术时间、尿管留置时间及术后住院时间为(142.86±17.08)mL、(95.95±10.12)min、(2.23±0.25)d、(5.63±0.59)d,均小于TURP组[(211.64±24.05)mL、(109.87±13.17)min、(3.66±0.39)d、(8.85±0.91)d],前列腺切除质量为(47.06±4.92)g,大于TURP组[(36.95±3.98)g],差异均有统计学意义(P<0.05)。术后7 d,HoLEP组血清fPSA、VEGF水平为(1.95±0.20)ng/mL、(58.42±6.16)pg/mL,均小于TURP组[(2.05±0.23)ng/mL、(55.60±6.11)pg/mL],差异均有统计学意义(P<0.05)。术后6个月,HoLEP组IPSS评分为(2.45±0.27)分,低于TURP组[(3.02±0.337)分],改良性生活质量调查表(mSLQQ-QoL)及国际勃起功能问卷-5(IIEF-5)为(35.29±3.83)、(16.75±1.95)分,均高于TURP组[(31.64±3.42)、(13.71±1.62)分],差异均有统计学意义(P<0.05)。HoLEP组术后并发症发病率为6.67%,低于TURP组(20.00%),差异有统计学意义(P<0.05)。结论与TURP比较,HoLEP治疗BPH可有效切除增生前列腺,抑制生成fPSA、VEGF,改善前列腺增生症状,提高患者性生活质量,减少术后并发症。

Objective To study the effect of Holmium laser enucleation of the prostate(HoLEP)for the treatment of BPH and its effect on free prostate specific antigen(fPSA),vascular endothelial growth factor(VEGF)and sexual life quality.Methods A total of 120 patients with BPH treated in Department of Urology,Cangzhou People’s Hospital from Mar 2019 to Mar 2021 were prospectively choiced and divided into HoLEP group and TURP group,each 60 casee according to the random number table method.The HoLEP group underwent HoLEP,and the TURP group underwent transurethral resection of prostate(TURP).The perioperative indicators,serum levels of fPSA and VEGF before operation and 7d after operation,before operation and 6 months after operation,prostatic hyperplasia and quality of sexual life,postoperative complications were observed.Results The intraoperative blood loss,operation time,catheter indwelling time and postoperative hospital stay in the HoLEP group were(142.86±17.08)mL,(95.95±10.12)min,(2.23±0.25)d,(5.63±0.59)d,which were lower than those in the TURP group[(211.64±24.05)mL,(109.87±13.17)min,(3.66±0.39)d,(8.85±0.91)d],and the prostate resection quality was(47.06±4.92)g,which was higher than that in the TURP group[(36.95±3.98)g],the differences were statistically significant(P<0.05).At 7 d after operation,the levels of serum fPSA and VEGF in HoLEP group were(1.95±0.20)ng/mL,(58.42±6.16)pg/mL,which were lower than those in TURP group[(2.05±0.23)ng/mL,(55.60±6.11)pg/mL],the differences were statistically significant(P<0.05).At 6 months after operation,the IPSS scores of HoLEP group were(2.45±0.27)scores,which were lower than those of TURP group[(3.02±0.337)scores],and the modified sexual life quality questionnaire(mSLQQ-QOL)and International Erectile Function Questionnaire-5(IIEF-5)scores of HoLEP group were(35.29±3.83),(16.75±1.95)scores,which were higher than those of TURP group[(31.64±3.42),(13.71±1.62)scores],the differences were statistically significant(P<0.05).The incidence of postoperative complications in HoLEP group was 6.67%,which was lower than that in TURP group(20.00%),the difference was statistically significant(P<0.05).Conclusion Compared with TURP,HoLEP in the treatment of BPH can effectively remove hyperplastic prostate,inhibit the production of fPSA and VEGF,improve the symptoms of prostatic hyperplasia,improve the quality of sexual life of patients,and reduce postoperative complications.