经尿道前列腺铥激光剜除术与绿激光剜除术治疗前列腺增生的比较研究

Clinical comparison between thulium laser transurethral enucleation of the prostate and green laser transurethral enucleation of the prostate in the treatment of benign prostatic hyperplasia

目的:对比经尿道前列腺铥激光剜除术(ThuLEP)与经尿道前列腺绿激光剜除术(GreenLEP)治疗良性前列腺增生(BPH)的临床疗效及安全性。方法:回顾性分析2021年7月—2022年12月我院开展的50例激光前列腺剜除术的临床资料,其中ThuLEP和GreenLEP各25例,采用“分叶法”解剖性剜除,比较两组之间的手术时间、手术前后血红蛋白下降值、膀胱冲洗时间、留置导尿管时间、术后住院时间、术中和术后并发症等,以对比手术安全性;比较术前和术后3个月的国际前列腺症状评分(IPSS)、生活质量评分(QoL)和残余尿量(PVR)等指标,以对比其临床疗效。结果:ThuLEP组的手术时间、术后血红蛋白下降值少于GreenLEP组,差异有统计学意义(P<0.05);而术后膀胱持续冲洗时间、术后留置导尿管时间和术后住院时间均差异无统计学意义。两组患者的术中和术后并发症均较低,无严重并发症发生。ThuLEP组总的并发症发生率为32%(尿道狭窄1例、暂时性尿失禁3例、尿路感染5例),GreenLEP组总的并发症发生率为36%(继发性出血1例、尿道狭窄1例、暂时性尿失禁3例、尿路感染4例),差异无统计学意义。两组患者术后3个月随访,IPSS、QoL和PVR等指标均较术前明显改善(均P<0.01),两组间差异无统计学意义。结论:ThuLEP和GreenLEP均是治疗BPH较好的手术选择,效果确切、安全性高。铥光纤激光因其更优的精准切割和止血性能,较绿激光更有优势,具有更广的适用范围。

Objective To compare the clinical efficacy and safety between thulium laser transurethral enucleation of the prostate(ThuLEP)and green laser transurethral enucleation of the prostate(GreenLEP)in the treatment of benign prostatic hyperplasia(BPH).Methods The clinical data of 50 cases of laser enucleation of the prostate from July 2021 to December 2022 were retrospectively analyzed,including 25 cases of ThuLEP and 25 cases of GreenLEP respectively.'Lobulation method'was used in the anatomical enucleation of prostate.The safety of operations was compared through the clinical indexes of the operative time,postoperative hemoglobin decrease,bladder irrigation time,indwelling catheter time,postoperative hospitalization time and postoperative complications.The clinical efficacy of operations was analyzed by the clinical indexes of International Prostate Symptom Score(IPSS),Quality of Life(QoL)and postvoiding residual urine volume(PVR).Results The operative time and postoperative hemoglobin decrease in the ThuLEP group were less than those in the GreenLEP group(P<0.05),but there was no significant difference in the indexes of postoperative bladder irrigation time,indwelling catheter time or postoperative hospitalization stay.The intraoperative and postoperative complications of the two groups were low,and no serious complications occurred.The total complication rates were 32%in the ThuLEP group(1 case of urethral stricture,3 cases of temporary urinary incontinence,5 cases of urinary tract infection),and 36%in the GreenLEP group(1 case of secondary hemorrhage,1 case of urethral stricture,3 cases of temporary urinary incontinence,4 cases of urinary tract infection),and the differences were not statistically significant.Compared with preoperative indicators,the indicators of IPSS,QoL and PVR were significantly improved 3 months after operation in both groups(P<0.05).However,there were no significant differences in postoperative indexes between the two groups.Conclusion Both ThuLEP and GreenLEP are good surgical options for the treatment of BPH,with accurate efficiency and high safety.Thulium fiber laser has more advantages than green laser because of its better precision cutting and hemostasis performance.Therefore,ThuLEP is a superior method and is worthy of clinical application.