尖部黏膜预离断整叶法在经尿道钬激光前列腺剜除术中的应用

Application of en-bloc Holmium laser enucleation of the prostate with an early apical mucosa dissection

目的探讨尖部黏膜预离断整叶法经尿道钬激光前列腺剜除术(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—2023年1月于首都医科大学附属北京友谊医院泌尿外科进行HoLEP治疗的215例BPH患者的临床资料,根据治疗方式不同,将患者分为研究组(n=112)和对照组(n=103)。研究组患者采用尖部黏膜预离断整叶法HoLEP术,对照组患者采用2叶或3叶常规HoLEP术。主要观察指标为两组患者术后1、3、6个月的尿失禁发生率,次要观察指标包括手术时间、术后血红蛋白下降值、组织切除量、术后留置尿管时间、术后住院时间及术后3、6个月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(±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Wilcoxon或者Mann-WhitneyU检验;计数资料组间比较采用χ^(2)检验。结果研究组患者术后1、3个月尿失禁发生率分别为9.0%(10/112)和3.6%(4/112),显著低于对照组的18.5%(19/103)和11.7%(12/103),差异均具有统计学意义(P<0.05)。术后6个月,两组患者尿失禁均完全康复。研究组患者的手术时间为(68.74±23.71) min,低于对照组的(88.04±25.43) min,差异具有统计学意义(P<0.05)。两组患者的术后血红蛋白下降值、组织切除量、术后留置尿管时间、术后住院时间比较,差异均无统计学意义(P>0.05)。两组患者术后3、6个月的IPSS、QoL评分、Qmax、PVR均较术前明显改善(P<0.05),但是两组间比较差异均无统计学意义(P>0.05)。结论尖部黏膜预离断整叶法HoLEP治疗BPH,较常规HoLEP术后早期尿失禁发生率低,手术时间短,且安全可靠。

Objective To investigate the efficacy and safety of en-bloc Holmium laser enucleation of the prostate(HoLEP)with an early apical mucosa dissection technique for the treatment of benign prostate hyperplasia(BPH).Methods The clinical data of 215 patients treated with HoLEP for BPH from January 2020 to January 2023 in the Department of Urology,Beijing Friendship Hospital,Capital Medical University were retrospectively analyzed.According to different treatment methods,the patients were divided into study group(n=112)and control group(n=103).Patients in the study group were treated by the en-bloc HoLEP with an early apical mucosa dissection technique,while patients in the control group were treated by the classical two or three-lobes HoLEP.The primary endpoints included the rates of urinary incontinence at 1-month,3-month,and 6-month after surgery in two groups of patients.The secondary endpoints included operative time,hemoglobin decrease,dissected prostate weight,postoperative indwelling catheter time,postoperative hospital stay,and international prostate symptom score(IPSS),quality of life(QoL),Qmax,and postvoid residual urine(PVR)at 3-month and 6-month after surgery.The measurement data were tested by Shapiro-Wilk normality test.The normal distribution of the measurement data were expressed as mean±standard deviation(±s),and independent sample t-test was used for comparison between two groups.Measurement data of skewness distribution were expressed as median(interquartile distance)[M(Q1,Q3)],and Wilcoxon or Mann-Whitney U test were used for comparison between two groups.The count data in the two groups were compared by the Chi-square test.Results The incidence of urinary incontinence in the study group was 9.0%(10/112)and 3.6%(4/112)at 1-month and 3-month after surgery,which was significantly lower than those in the control group[18.5%(19/103)and 11.7%(12/103)],and the differences were statistically significant(P<0.05).Urinary incontinence in two groups recovered completely 6-month after surgery.The operation time of the study group was(68.74±23.71)min,which was lower than that of the control group[(88.04±25.43)min],and the difference was statistically significant(P<0.05).There were no significant differences in hemoglobin decrease,dissected prostate weight,postoperative indwelling catheter time,postoperative hospital stay in the two groups(P>0.05).The IPSS,QoL,Qmax and PVR of the two groups were significantly improved at 3-month and 6-month after surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion En-bloc HoLEP with an early apical mucosa dissection technique is safe and reliable in treating BPH,and has advantages over classic HoLEP in terms of short-term urinary continence rates,shortening operation time.