钬激光前列腺剜除术与等离子前列腺剜除术治疗良性前列腺增生的临床效果比较

Comparison of Clinical Effects of Holmium Laser Enucleation of Prostate and Plasma Kinetic Enucleation of Prostate for Benign Prostatic Hyperplasia

目的比较钬激光前列腺剜除术(HoLEP)与等离子前列腺剜除术(PKEP)治疗良性前列腺增生(BPH)的临床效果。方法选取2018年9月至2023年9月上海杨思医院收治的162例BPH患者为研究对象,根据治疗方案不同分为两组,HoLEP组(82例)进行HoLEP治疗,PKEP组(80例)进行PKEP治疗。比较两组患者的围手术期指标、视觉模拟评分法(VAS)评分,术前和术后血清表皮生长因子(EGF)、前列腺特异性抗原(PSA)水平以及尿动力学指标[最大尿流率(Qmax)、残余尿量(PVR)、膀胱顺应性(BC)],记录两组患者术后并发症发生情况。结果HoLEP组患者手术时间、膀胱冲洗时间、术中出血量及导尿管留置时间均少于PKEP组[(94±7)min比(117±8)min、(39.4±2.8)h比(61.2±3.1)h、(51±3)ml比(67±4)ml、(2.8±0.8)h比(4.3±1.2)h](P<0.01)。HoLEP组VAS评分显著低于PKEP组[(4.4±0.4)分比(5.5±0.6)分](t=14.589,P<0.001)。手术前后血清EGF、PSA水平的主效应差异有统计学意义(P<0.01),不考虑测量时间,两组间血清EGF、PSA水平的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.05);与术前相比,术后两组血清EGF、PSA水平均显著降低(P<0.05),且HoLEP组显著低于PKEP组(P<0.05)。手术前后Qmax、PVR、BC的主效应差异有统计学意义(P<0.01),不考虑测量时间,两组间Qmax、PVR、BC的主效应差异有统计学意义(P<0.05或P<0.01),组间和时点间存在交互作用(P<0.05或P<0.01);与术前相比,术后两组PVR均显著降低(P<0.05),而Qmax、BC显著升高(P<0.05);术后,与PKEP组相比,HoLEP组Qmax升高(P<0.05),PVR、BC降低(P<0.05)。HoLEP组患者术后并发症总发生率显著低于PKEP组[2.44%(2/82)比11.25%(9/80)](χ^(2)=4.967,P=0.026)。结论与PKEP相比,HoLEP对BPH患者的治疗效果更佳,且能更有效地改善患者血清EGF、PSA水平及尿动力学指标。

Objective To compare the clinical effects of holmium laser enucleation of prostate(HoLEP)and plasma kinetic enucleation of prostate(PKEP)in the treatment of benign prostatic hyperplasia(BPH).Methods A total of 162 BPH patients admitted to Shanghai Yangsi Hospital from Sep.2018 to Sept.2023 were included,into two groups based on the therapy protocol,namely HoLEP group(82 cases)and PKEP group(80 cases).The HoLEP group was treated with HoLEP,and the PKEP group was treated with PKEP.Perioperative indicators,visual analogue scale(VAS)scores,preoperative and postoperative serum epidermal growth factor(EGF),prostate-specific antigen(PSA)levels,and urinary kinetic indicators[maximum urinary flow rate(Qmax),postvoid residual urine(PVR),bladder compliance(BC)]in the two groups were discussed and compared.The occurrence of postoperative complications was recorded in both groups.Results The surgical time,bladder washing time,intraoperative bleeding volume and retention time of urinary catheter of the HoLEP group were less than those in the PKEP group[(94±7)min vs(117±8)min,(39.4±2.8)h vs(61.2±3.1)h,(51±3)ml vs(67±4)ml,(2.8±0.8)h vs(4.3±1.2)h](P<0.01).The VAS score was significantly lower in the HoLEP group than that in the PKEP group(4.4±0.4 vs 5.5±0.6)(t=14.589,P<0.001).The differences in main effects of serum EGF and PSA levels before and after surgery were statistically significant(P<0.01),regardless of the measurement time,the main effect differences of serum EGF and PSA levels between two groups were statistically significant(P<0.01),and there were interactions between groups and time points(P<0.05).The postoperative serum EGF and PSA levels of the two groups were significantly lower than the preoperative levels(P<0.05),and the HoLEP group was significantly lower than the PKEP group(P<0.05).The differences in the main effects of Qmax,PVR and BC before and after surgery were statistically significant(P<0.01),regardless of the measurement time,the main effect differences of Qmax,PVR and BC were statistically significant between groups(P<0.05 or P<0.01),and there were interactions between groups and time points(P<0.05 or P<0.01).Compared with before surgery,PVR of both groups was significantly decreased(P<0.05),while Qmax and BC were significantly increased(P<0.05).After surgery,compared with the PKEP group,Qmax was higher in the HoLEP group(P<0.05),and PVR and BC were lower(P<0.05).The overall incidence of postoperative complications in the HoLEP group was significantly lower than that in the PKEP group[2.44%(2/82)vs 11.25%(9/80)](χ^(2)=4.967,P=0.026).Conclusion Compared with PKEP,HoLEP is more effective in the treatment of BPH patients,and can more effectively improve serum EGF,PSA levels and urodynamic indexes of the patients.