整叶法低功率钬激光前列腺剜除术治疗良性前列腺增生的疗效分析

Clinical effect analysis of en-bloc low-power holmium laser enucleation of prostate in the treatment of benign prostatic hyperplasia

目的探讨整叶法低功率(22.5 W)钬激光前列腺剜除术(LP-HoLEP)治疗良性前列腺增生(BPH)的有效性和安全性。方法回顾性分析2020年1月—2022年10月于首都医科大学附属北京友谊医院泌尿外科进行手术治疗的98例BPH患者的临床资料,根据治疗方法的不同将其分为LP-HoLEP组(n=53)和TURP组(n=45)。LP-HoLEP组患者采用整叶法LP-HoLEP治疗,TURP组患者采用经尿道前列腺切除术(TURP)治疗。比较两组患者的围手术期指标,包括手术时间、术后血红蛋白变化、组织切除量、术后留置尿管时间、术后住院时间、并发症,以及术后3个月和6个月的国际前列腺症状评分(IPSS)、生活质量(Qol)评分、最大尿流率(Qmax)、残余尿量(PVR)等指标。计量资料经Shapiro-Wilk正态性检验,符合正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用独立样本t检验;不符合正态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ^(2)检验。结果LP-HoLEP组患者的手术时间为(65.74±22.82)min,血红蛋白下降5.71(3.97,9.01)g/L,组织切除量为(60.59±24.40)g,术后留置尿管时间为(3.03±0.91)d,术后住院时间为(4.14±1.05)d;TURP组分别为(77.04±27.33)min、11.02(8.89,16.51)g/L、(39.49±11.32)g、(4.80±0.91)d、(5.98±1.03)d,LP-HoLEP组患者各项指标均优于TURP组,差异均具有统计学意义(P<0.05)。两组患者术后3个月的IPSS、Qol评分、Qmax、PVR均较术前明显改善,但是组间比较差异无统计学意义(P>0.05)。结论整叶法LP-HoLEP治疗BPH安全可靠,且在组织切除量、缩短住院时间及留置尿管时间、减少术中出血量方面较TURP更具有优势。

Objective To investigate the efficacy and safety of en-bloc low-power(22.5 W)holmium laser for enucleation of prostate(LP-HoLEP)in the treatment of benign prostatic hyperplasia(BPH).Methods The clinical data of 98 patients with BPH who underwent surgical treatment in the Department of Urology,Beijing Friendship Hospital,Capital Medical University from January 2020 to October 2022 were retrospectively analyzed.They were divided into LP-HoLEP group(n=53)and TURP group(n=45)according to different treatment methods.Patients in the LP-HoLEP group were treated with en-bloc holmium laser enucleation of prostate,and patients in the TURP group were treated with transurethral resection of prostate(TURP).Perioperative indexes of the two groups were compared,including operation time,postoperative hemoglobin changes,tissue resection amount,postoperative catheter indentation time,postoperative hospital stay,complications,and international prostate symptom score(IPSS),quality of life(Qol)score,maximum urine flow rate(Qmax),postvoid residual volume(PVR)and other indicators were obtained at 3 and 6 months after surgery.The measurement data were tested by Shapiro-Wilk normality test.The measurement data conforming to normal distribution were expressed as mean±standard deviation(x±s),independent sample t-test was used for comparison between groups,measurement data of skewness distribution were expressed as median(interquartile distance)[M(Q_(1),Q_(3))],and Mann-Whitney U test was used for comparison between groups.The Chi-square test was used to compare the count data between groups.Results In the LP-HoLEP group,the operative time was(65.74±22.82)min,the hemoglobin decreased 5.71(3.97,9.01)g/L,the tissue resection volume was(60.59±24.40)g,and the catheter indinduration time was(3.03±0.91)d.The length of postoperative hospitalization was(4.14±1.05)d.TURP group was(77.04±27.33)min,11.02(8.89,16.51)g/L,(39.49±11.32)g,(4.80±0.91)d,(5.98±1.03)d,respectively.All the indexes of LP-HoLEP group were better than TURP group.The differences were statistically significant(P<0.05).Compared with preoperative,IPSS,Qol score,Qmax and PVR of two groups were significantly improved at 3 months after surgery,but there were no statistical significance between groups(P>0.05).Conclusion En-bloc LP-HoLEP is safe and reliable in the treatment of BPH,and has advantages over TURP in terms of tissue resection volume,shortening hospitalization and indwelling catheter time,and reducing intraoperative bleeding.