等离子双极前列腺剜除术与红激光前列腺剜除术在BPH患者日间手术中的疗效对比

Transurethralplasmakineticbipolar enucleation of the prostate and diode laser enucleation of the prostate in day surgery patients

目的对比经尿道等离子双极前列腺剜除术与红激光前列腺剜除术在良性前列腺增生(BPH)患者日间手术中的有效性和安全性。方法回顾性分析2019年8月至2021年8月于南方医科大学珠江医院行日间手术的99例BPH患者的临床资料。其中47例采用等离子双极前列腺剜除术,为双极组;52例采用红激光前列腺剜除术,为红激光组。两组患者年龄[57.0(56.0,61.0)岁与59.0(57.0,62.0)岁]、前列腺体积[(60.0±8.2)ml与(57.4±9.4)ml]及术前总前列腺特异性抗原(tPSA)[(1.8±0.9)ng/ml与(2.2±0.9)ng/ml]、残余尿量(PVR)[20.0(0,40.0)ml与20.0(1.3,41.5)ml]、最大尿流率(Q_(max))[(9.4±2.6)ml/s与(9.6±1.9)ml/s]、国际前列腺症状评分(IPSS)[19.0(16.0,21.0)分与19.0(18.0,21.0)分]、生活质量评分(Q0L)[5.0(4.0,5.0)分与5.0(4.0,5.0)分]、国际勃起功能指数(IIEF-5)评分[(18.8±1.0)分与(19.2±0.9)分]差异无统计学意义(均P>0.05)。比较两组的手术时间,以及术后血红蛋白下降值、血钠下降值、膀胱冲洗时间、尿管留置时间。术后1个月门诊复查。比较两组术后1个月Q_(max)、IPSS、QOL、IIEF-5评分等指标。结果所有患者均顺利完成手术,无严重术中并发症发生。双极组手术时间低于红激光组[(57.3±4.2)min与(64.4±6.3)min,P<0.001],两组术后血红蛋白下降值差异无统计学意义[(9.8±4.3)g/L与(8.5±4.3)g/L,P=0.154],两组均无患者输血治疗,均无严重血尿或需再次入院处理者。双极组与红激光组术后血钠下降值[1.7(1.3,2.0)mmol/L与1.7(1.5,1.9)mmol/L]、膀胱冲洗时间[(7.7±1.4)h与(8.0±1.6)h]差异均无统计学意义(P>0.05)。双极组和红激光组分别有8例和7例患者因术中发现前列腺炎性改变而留置尿管至术后48~60h,其余患者均在术后24 h内拔除尿管。双极组和红激光组术后1个月的Q_(max)分别为(20.4±1.8)、(21.1±1.7)ml/s,IPSS评分分别为7.0(7.0,8.0)7.0(7.0,8.0)分,Q0L评分分别为3.0(3.0,3.0)3.0(2.0,3.0)分,两组上述指标差异均无统计学意义(P>0.05)。结论等离子双极前列腺剜除术与红激光前列腺剜除术用于BPH患者的日间手术,术后短期Q_(max)、IPSS、血红蛋白降低值等指标无明显差异,二者有相同的疗效和安全性。

Objective To compare the clinical safety and the efficacy of the transurethral plasmakinetic bipolar enucleation of the prostate and diode laser enucleation of the prostate in day surgery patients.Methods The clinical data of 99 patients with benign prostatic hyperplasia(BPH)who underwent day surgery in Zhujiang Hospital of Southern Medical University from August 2019 to August 2021 were retrospectively analyzed.Among them,47 cases underwent transurethral plasmakinetic bipolar enucleation of the prostate(bipolar group),and 52 cases were treated with diode laser enucleation of the prostate(diode laser group).There were no significant differences in age[57.0(56.0,61.0)years old vs.59.0(57.0,62.0)years old],prostate volume[(60.0±8.2)ml vs.(57.4±9.4)ml],preoperative total prostate-specific antigen(tPSA)[(1.8±0.9)ng/ml and(2.2±0.9)ng/ml],postvoid residual(PVR)[20.0(0,40.0)ml vs.20.0(1.3,41.5)ml],maximum flow rate(Q_(max))[(9.4±2.6)ml/s vs.(9.6±1.9)ml/s],International Prostate Symptom Score(IPSS)[19.0(16.0,21.0)vs.19.0(18.0,21.0)],quality of life(QOL)[5.0(4.0,5.0)vs.5.0(4.0,5.0)]and International Index of Erectile Function 5(IIEF-5)[(18.8±1.0)vs.(19.2±0.9)]score between the bipolar group and diode laser group(all P>0.05).The indexes of operation time,postoperative hemoglobin decline,blood sodium decline,bladder irrigation time,catheter indwelling time,Q_(max),IPSS,QOL,IIEF-5 score and so on were compared between the two groups.Results All day surgeries were successfully completed without serious complications.The operation time of the bipolar group was less than that of the diode laser group[(57.3±4.2)vs.(64.4±6.3)min,P<0.001],and no statistically significant difference was found in the postoperative hemoglobin decline between the two groups[(9.8±4.3)g/L vs.(8.5±4.3)g/L,P=0.154].None of the patients received transfusion treatment,and neither group of patients had severe hematuria or needed to be readmitted to hospital.There was no significant difference in the decrease of blood sodium[1.7(1.3,2.0)mmol/L vs.1.7(1.5,1.9)mmol/L]and the postoperative bladder irrigation time[(7.7±1.4)h vs.(8.0±1.6)h]between the bipolar and diode laser groups(P>0.05).There were 8 patients in the bipolar group and 7 patients in the diode laser group who retained urinary catheter for 48-60 h due to intraoperative inflammatory changes in the prostate,and the remaining patients had their urinary catheter removed within 24 hours.The Q_(max) of the bipolar group and the diode laser group one month after surgery were(20.4±1.8)and(21.1±1.7)ml/s,IPSS scores were 7.0(7.0,8.0)and 7.0(7.0,8.0),and Q0L scores were 3.0(3.0,3.0)and 3.0(2.0,3.0),respectively.There were no significant differences in Q_(max),IPSS and QOL between the two groups(all P>0.05).Conclusions Transurethral plasmakinetic bipolar enucleation of the prostate is also feasible for day surgery,and the short-term postoperative Q_(max),IPSS,hemoglobin reduction and other indicators have no significant difference compared with diode laser enucleation of the prostate,and can achieve the same efficacy and safety as diode laser enucleation of prostate.