不同途径前列腺穿刺后的BPH患者行经尿道前列腺钬激光剜除术的疗效比较

Comparison of the Therapeutic Effect of Transurethral Holmium Laser Enucleation in Patients with BPH after Transrectal or Transperineal Prostate Biopsy

目的观察分析血清PSA异常的经直肠和经会阴两种不同途径前列腺穿刺后诊断为前列腺增生(BPH)患者行经尿道前列腺钬激光剜除术(HoLEP)的安全性和有效性。方法回顾性分析2018年1月-2020年6月在中国科学技术大学附属第一医院(安徽省立医院)接受HoLEP治疗的60例前列腺穿刺后BPH患者的临床资料,依据前列腺穿刺活检路径将患者分为经会阴组(29例)与经直肠组(31例),收集两组患者的基线资料、围手术期指标及术后3个月、6个月的随访情况数据来分析两组之间的差异。结果经直肠组的手术时长、术后导尿时间长于经会阴组,差异有统计学意义(P<0.05)。经会阴组术后总并发症发生率低于经直肠组,差异有统计学意义(P<0.05)。两组患者术后3个月、6个月的国际前列腺症状评分(IPSS)、前列腺症状生活质量评分(QOL)及最大尿流率(Qmax)比较,差异无统计学意义(P>0.05)。结论经会阴或经直肠前列腺穿刺活检后3周左右的BPH患者行HoLEP治疗疗效确切且安全;经会阴穿刺后的BPH患者行HoLEP治疗与经直肠组比较,手术时间及留置导尿时间更短,手术后出现并发症的概率更小。

Objective To observe and analyze the safety and eff ectiveness of transurethral holmium laser enucleation of the prostate(HoLEP)in patients with BPH after transrectal or transperineal prostate biopsy.Methods The data of 60 BPH patients who underwent HoLEP in the Department of Urology,First Affiliated Hospital of USTC(Anhui Provincial Hospital)from January 2018 to June 2020 were collected.All the patients are diagnosed by prostate biopsy and divided into transperineal group and transrectal group according to the operational approach.There were 29 cases in the transperineal group and 31 cases in the transrectal group.The basic information,perioperative indicators and follow-up data of 3 and 6 months after surgery were collected and analyzed.Results The length of surgery and postoperative catheterization time in the transrectal group was longer than that in the transperineal group,and the diff erence was statistically signifi cant(P<0.05).The overall postoperative complication rate was lower in the transperineal group than in the transrectal groupthe transperineal group,the difference between the two groups was statistically signifi cant(P<0.05).Comparison of the International Prostate Symptom Score(IPSS),Quality of Life Score(QOL)for prostate symptoms and maximal urinary fl ow rate(Qmax)of patients in the two groups at 3 and 6 months postoperatively,the diff erence was not statistically signifi cant(P>0.05).Conclusion HoLEP treatment for BPH patients at 3 weeks after transperineal or transrectal prostate biopsy is eff ective and safe.In the patients who underwent HoLEP after transperineal biopsy,the operation time and indwelling catheterization time are shorter and has fewer complications postoperatively.