单中心10年2050例良性前列腺增生手术围手术期数据分析

Data analysis of perioperative period in 2050 cases of benign prostatic hyperplasia surgery in a single center over 10 years

目的总结分析良性前列腺增生(BPH)手术术式的变化及临床疗效。方法回顾性分析2012年1月-2022年8月于解放军总医院第一医学中心泌尿外科接受BPH手术治疗的2050例患者的临床资料。按时间顺序将患者分为前期组(n=683)、中期组(n=683)、后期组(n=684),各组患者累计时间分别为2012年1月-2017年2月、2017年3月-2020年9月及2020年10月-2022年8月。收集并比较各组患者年龄、高血压、糖尿病、血清胆固醇、血清三酰甘油、血清高密度脂蛋白胆固醇、体重指数(BMI)、术前前列腺体积、前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)、手术时间、术前住院时间、术后住院时间、术后膀胱冲洗时间、术后尿管留置时间、膀胱造瘘情况、术中和术后输血情况、术后再入院率、术后病理等指标。分析BPH手术量及手术方式的逐年变化趋势。结果经尿道前列腺电切术(TURP)及TURP+激光术式逐年减少,而经尿道前列腺激光剜除术占比不断增高,并在近两年成为主流术式;前期组、中期组、后期组患者年龄分别为(69.7±7.9)岁、(68.7±7.4)岁和(69.8±8.5)岁(P=0.027);手术时间分别为108.0(80.0,130.0)min、80.0(60.0,110.0)min和75.0(60.0,100.0)min(P<0.001);术后尿管留置时间分别为4.1(2.7,5.9)d、3.9(2.9,4.9)d和2.7(0.9,3.9)d(P<0.001);膀胱造瘘率分别为68.8%、66.6%和5.0%(P<0.001);术中及术后输血率分别为4.5%、3.1%、0.9%(P<0.001);术前住院时间分别为5.6(3.8,7.1)d、4.7(3.5,5.9)d和4.7(3.1,6.7)d(P<0.001);术后住院时间分别为5.7(4.8,7.0)d、4.7(3.0,5.9)d和2.8(1.0,4.0)d(P<0.001),差异均有统计学意义。本中心10年BPH手术患者术后再次入院37例(1.8%),术后病理异常或病理确诊为前列腺癌64例,总检出率为3.1%。结论前列腺激光剜除术已成为本中心BPH外科治疗的主流术式,手术时间、住院时间、术后尿管留置时间、膀胱造瘘率、手术输血率等围手术期相关指标均呈现明显改善的趋势。

Objective To summarize and analyze the surgical evolution and clinical efficacy of benign prostatic hyperplasia(BPH) surgery.Methods A retrospective cohort study was used to analyze the clinical data of 2050 patients who underwent surgery for BPH in the Department of Urology,the First Medical Center of PLA General Hospital from January 2012 to August 2022.These patients were divided into 3 groups in chronological order:the early group(n=683),the middle group(n=683) and the late group(n=684).The cumulative time of patients in each group was from January 2012 to February 2017,March 2017 to September 2020 and October 2020 to August 2022.The indicators,such as age,hypertension,diabetes,serum cholesterol,serum triacylglycerol,serum high-density lipoprotein cholesterol,body mass index(BMI),preoperative prostate volume,prostate specific antigen(PSA),free prostate specific antigen(fPSA),operation time,preoperative hospital stay,postoperative hospital stay,postoperative bladder flushing time,postoperative indwelling time,cystostomy situation,intraoperative and postoperative blood transfusion,postoperative readmission rate,and postoperative pathology were collected and compared between 3 groups,and the annual trend of changes in the number of BPH surgeries and surgical methods was analyzed.Results Transurethral resection of prostate(TURP) and TURP+laser resection decreased year by year,while transurethral laser resection of prostate increased and became the mainstream prostate resection method in recent two years,accounting for more than 90%.The patients in the early,middle and late groups were(69.7±7.9) years old,(68.7±7.4) years old and(69.8±8.5) years old(P=0.027);the operation time was 108.0(80.0,130.0) min,80.0(60.0,110.0) min and 75.0(60.0,100.0) min(P<0.001);the postoperative indwelling time was 4.1(2.7,5.9) d,3.9(2.9,4.9) d and 2.7(0.9,3.9) d(P<0.001);the rates of cystostomy were 68.8%,66.6% and 5.0%(P<0.001);the intraoperative and postoperative blood transfusion rates were 4.5%,3.1% and 0.9%(P<0.001);the preoperative hospitalization time was 5.6(3.8,7.1) d,4.7(3.5,5.9) d,and 4.7(3.1,6.7) d(P<0.001);the postoperative hospital stays were 5.7(4.8,7.0) d,4.7(3.0,5.9) d and 2.8(1.0,4.0) d(P<0.001),with statistically significant differences.Thirty-seven cases(1.8%) of BPH patients who underwent surgery in our center for 10 years were re-admitted after surgery,and 64 cases had postoperative pathological abnormalities or were diagnosed with prostate cancer,with a total detection rate of 3.1%.Conclusions Laser enucleation of prostate has become the mainstream surgical treatment of BPH in our center,and perioperative indexes such as operation time,hospital stay,postoperative catheter indwelling time,cystostomy rate,and surgical blood transfusion rate have shown a significant improvement trend.