经尿道蓝激光前列腺切开术治疗小体积良性前列腺增生的临床疗效

Efficacy of transurethral blue laser prostatomy in the treatment of small volume benign prostatic hyperplasia

目的分析经尿道蓝激光前列腺切开术(BLTUIP)治疗小体积(≤30 mL)良性前列腺增生(BPH)的临床效果与可行性。方法回顾性分析2023年3—10月新疆医科大学第一附属医院泌尿中心接受BLTUIP治疗的34例BPH患者的临床资料。记录患者的手术时间、450 nm蓝激光出光时间、980 nm红激光出光时间、术后膀胱冲洗时间等。比较患者术前、术后3及6个月的国际前列腺症状评分(IPSS)、生活质量评定量表评分(QoL)、最大尿流率(Qmax)、残余尿量(PVR)、国际勃起功能指数(IIEF-5)、射精情况及术后并发症发生率。结果34例患者均顺利完成手术,无术中转开放或转经尿道前列腺电切术(TURP)治疗者。手术时间12.7(10.8,14.3)min,450 nm蓝激光出光时间11.7(9.6,13.3)min,980 nm红激光出光时间1.0(1.0,2.0)min,术后膀胱冲洗时间5.0(2.8,8.0)h,总住院时间6.0(4.0,7.0)d,术后住院时间2.0(2.0,3.0)d,术后尿管留置时间2.0(0,2.0)d。术后随访3及6个月,患者的IPSS、QoL及PVR均较术前明显降低,Qmax较术前明显增大,差异均有统计学意义(P<0.001),但IIEF-5评分与术前比较差异无统计学意义(P>0.05)。随访发现,术后3个月内,有4例患者(11.8%)发热;术后3~6个月内,有1例(2.9%)尿道外口狭窄。术前有性生活史的8例患者中,术后有1例(12.5%)发生逆行射精,所有患者术后随访过程中均未发生血尿。结论BLTUIP治疗体积≤30 mL的BPH,可缩短手术时间、减少术后并发症发生率、改善患者生活质量,是一种新型、安全、高效的手术方法。

Objective To explore the clinical efficacy and feasibility of blue laser transurethral incision of prostate(BLTUIP)in the treatment of small volume(≤30 mL)benign prostatic hyperplasia(BPH).Methods The clinical data of 34 BPH patients treated with BLTUIP in the First Affiliated Hospital of Xinjiang Medical University during Mar.and Oct.2023 were retrospectively analyzed.The operation time,450 nm blue laser light emission time,980 nm red laser light emission time,postoperative bladder irrigation time,international prostate symptom score(IPSS),quality of life score(QoL),maximum flow rate(Qmax),post-void residual(PVR),international index of erectile function-5(IIEF-5),ejaculation and incidence of postoperative complications were analyzed.Results All operations were successful,without conversion to open or transurethral resection of the prostate(TURP).The operation time was 12.7(10.8,14.3)min,the 450 nm blue laser light emission time was 11.7(9.6,13.3)min,the 980 nm red laser light emission time was 1.0(1.0,2.0)min,the postoperative bladder irrigation time was 5.0(2.8,8.0)h,the total hospital stay was 6.0(4.0,7.0)d,the postoperative hospital stay was 2.0(2.0,3.0)d,and the postoperative catheter retention time was 2.0(0,2.0)d.After 3 or 6 months of follow-up,the IPSS,QoL and PVR were significantly lower than those before operation,while the Qmax was significantly higher,with significant differences(P<0.001);but there was no significant difference in the IIEF-5 score(P>0.05).During the 3-month follow-up,4 patients(11.8%)had fever;during the 3-6 month follow-up,1 patient(2.9%)had external urethral stricture;of the 8 patients with sexual life before operation,1(12.5%)had retrograde ejaculation after operation.No hematuria occurred.Conclusion BLTUIP is a new,safe and efficient surgical treatment for BPH with a volume≤30 mL,which can shorten the operation time,reduce postoperative complications,and improve the quality of life.