McNeal分带激光剜切汽化术对中重度前列腺增生症患者的尿控及射精功能保护作用研究

Urinary Control and Ejaculation Function Protection of McNeal Banding Laser Enucleation and Vaporization in Moderate and Severe Benign Prostatic Hyperplasia

目的探讨McNeal分带激光剜切汽化术(M-TULIP)对中重度前列腺增生症(BPH)患者的尿控及射精功能保护效果。方法采用前瞻性、单中心的研究方法,将2019年1月—2021年12月本院收治的174例行M-TULIP治疗的中重度BPH患者作为实验组,154例经尿道前列腺等离子剜除术(TURP)治疗的BPH患者作为对照组。根据术前估算的前列腺体积将患者再分为中度增生实验组(EM组)99例,中度增生对照组(CM组)94例,重度增生实验组(EL组)75例,重度增生对照组(CL组)60例。比较4组围术期相关指标、腺体切除率、术后并发症发生情况、勃起功能障碍(ED)和射精功能障碍(EjD)的发生率以及手术前后各评价量表评分、最大尿流率(Qmax)、残余尿量(PVR)。结果EM与CM组、EL与CL组、EM与EL组、CM与CL组的围术期相关指标、腺体切除率比较,差异均有统计学意义(均P<0.05);EM组并发症发生率低于CM组,EL组并发症发生率低于CL组,组间比较差异均有统计学意义(χ^(2)=3.888、6.371,均P<0.05);实验组ED、EjD的发生率均明显低于对照组,组间比较差异均有统计学意义(χ^(2)=66.024、165.270,均P<0.05);实验组和对照组术后Qmax、国际前列腺症状评分(IPSS)、生活质量评分(QoL)、PVR指标均较术前明显改善;EM组和EL组术后的IIEF-5评分、CIPE评分与术前比较,差异均无统计学意义(均P>0.05);EM组与CM组、EL组与CL组的术后IIEF-5评分、CIPE评分比较,差异均有统计学意义(t=12.351、27.008、6.167、21.748,均P<0.05)。结论M-TULIP与TURP具有基本相当的手术疗效。但M-TULIP的组织切除率更低,手术时间、术中出血量、住院时间、留置尿管时间等指标均优于TURP,且术后尿失禁、EjD、ED、尿道狭窄等发生率显著低于TURP。故对于中重度BHP患者,并非需要追求更高的切除比率及切除重量。M-TULIP具有临床应用优势,值得推广。

Objective To investigate the urinary control and ejaculation function protection of McNeal band laser enucleation and vaporization in patients with anterior moderate to severe benign prostatic hyperplasia(BPH).Methods Using a prospective,single-centre study,a total of 174 patients with moderate-to-severe BPH treated with M-TULIP admitted to our hospital from January 2019 to December 2021 were used as the experimental group,and 154 patients with BPH treated with transurethral plasma enucleation of prostate(TURP)were used as the control group.The patients were subdivided into 99 patients in the experimental group with moderate hyperplasia(EM group),94 patients in the control group with moderate hyperplasia(CM group),75 patients in the experimental group with severe hyperplasia(EL group)and 60 patients in the control group with severe hyperplasia(CL group)according to the preoperative estimated prostate volume.The four groups were compared in terms of perioperative related indicators,glandular resection rate,incidence of postoperative complications,incidence of erectile dysfunction(ED)and ejaculatory dysfunction(EjD),as well as preoperative and post-operative scores on each evaluation scale,maximum urinary flow rate(Qmax),and residual urine volume(PVR).Results The differences were statistically significant when comparing the perioperative related indexes and glandular resection rates between the EM and CM groups,EL and CL groups,EM and EL groups,and CM and CL groups(all P<0.05);the complication rates in the EM group were lower than those in the CM group,and those in the EL group were lower than those in the CL group,and the differences between the groups were statistically significant(χ^(2)=3.888,6.371,all P<0.05).The incidence of ED and EjD in the experimental group were significantly lower than that in the control group,and the difference between the groups was statistically significant(χ^(2)=66.024、165.270,all P<0.05);postoperative Qmax,International Prostate Symptom Score(IPSS),Quality of Life Score(QoL),and PVR indexes in the experimental and control groups were all improved significantly compared with those before surgery;the differences in IIEF-5 scores and CIPE scores after surgery in the EM and EL groups were not statistically significant when compared with those before surgery(all P>0.05);the differences in IIEF-5 scores and CIPE scores after surgery in the EM and CM groups and in the EL and CL groups were statistically significant(t=12.351,27.008,6.167,21.748,all P<0.05).Conclusion M-TULIP has essentially equivalent surgical efficacy to TURP.However,M-TULIP has a lower tissue resection rate,better operative time,intraoperative bleeding,hospital stay and indwelling urethral catheter than TURP,and the incidence of postoperative urinary incontinence,EjD,ED and urethral stricture is significantly lower than that of TURP.Therefore,for patients with moderate to severe BHP,it is not necessary to pursue a higher resection ratio and resection weight.M-TULIP has clinical application advantages and is worth promoting.