不同经尿道前列腺切除术治疗良性前列腺增生的疗效与安全性分析

Transurethral resection of prostate for treating benign prostatic hyperplasia:A comparative study of efficacy and safety of three procedures

目的探究不同经尿道前列腺切除术治疗良性前列腺增生的疗效与安全性分析。方法选取2021年1月至2023年5月本院收治的良性前列腺增生患者215例临床资料开展回顾性分析,根据手术方式分为经尿道前列腺等离子电切术治疗的等离子电切术组(n=81)、经尿道前列腺激光切除术治疗的激光切除术组(n=92)、经尿道前列腺绿激光剜除术治疗的绿激光剜除术组(n=42),比较三组围手术期指标(手术时间、术中出血量、膀胱冲洗时间、留置尿管时间、术后血红蛋白浓度、住院时间)、尿动力学指标(RUV、IPSS评分、Qmax、QOL评分)、术后并发症发生情况的差异。结果绿激光剜除术组、激光切除术组总有效率高于等离子电切术组(P<0.05)。3组住院时间比较差异无统计学意义(P>0.05),但绿激光剜除术组手术时间>激光切除术组>等离子电切术组(P<0.05),绿激光剜除术组、激光切除术组术中出血量、膀胱冲洗时间、留置尿管时间<等离子电切术组,且术后血红蛋白浓度>等离子电切术组(P<0.05)。重复测量方差分析结果显示,3组术后1个月、术后3个月RUV、IPSS评分、QOL评分与术前相比均降低,而Qmax与术前相比均升高(P<0.05),且激光切除术组与绿激光剜除术组术后1个月、术后3个月RUV、IPSS评分、QOL评分均低于等离子电切术组,Qmax均高于等离子电切术组(P<0.05),但激光切除术组与绿激光剜除术组术后1个月、术后3个月RUV、IPSS评分、Qmax、QOL评分比较差异无统计学意义(P>0.05)。绿激光剜除术组术后并发症总发生率<激光切除术组<等离子电切术组(7.14%vs.21.74%vs.35.80%,P<0.05)。结论3种手术方式治疗良性前列腺增生均具有较好疗效,但经尿道前列腺激光切除术与绿激光剜除术疗效与安全性均优于经尿道前列腺等离子电切术,可促进患者早期康复,且经尿道前列腺绿激光剜除术治疗安全性最好。

Objective To explore and compare the efficacy and safety of different transurethral enucle-ation procedures for treating benign prostatic hyperplasia.Methods A retrospective analysis was conducted on the clinical data of 215 patients with benign prostatic hyperplasia admitted to our hospital from January 2021 to May 2023.According to the surgical procedures,they were divided into plasma resection group(n=81),treated with transurethral plasma resection of the prostate,laser resection group(n=92),treated with transurethral laser resection of the prostate,and green laser enucleation group(n=42),treated with transurethral green laser enucle-ation of the prostate.The three groups were compared in terms of perioperative indicators(surgical time,intraop-erative bleeding volume,bladder flushing time,indwelling catheter time,postoperative hemoglobin concentration,and hospital stay),urodynamic indicators(RUV,IPSS score,Qmax,and QOL score),and postoperative compli-cations.Results The green laser enucleation group and laser resection group demonstrated a significantly higher total effective rate compared to the plasma electrosurgery group(P<0.05).The three groups showed no statisti-cally significant difference in hospital stay(P>0.05),but the green laser enucleation group showed a signifi-cantly shorter surgical time compared to the other two group(P<0.05).The green laser enucleation group and laser resection group had superiority in intraoperative bleeding,bladder flushing time,and indwelling catheter time compared to the plasma resection group,and a significantly higher postoperative hemoglobin concentration three groups all exhibited significantly decreases in RUV,IPSS score,and QOL score(P<0.05),and a signifi⁃cantly increase in Qmax at 1 month and 3 months after surgery(P<0.05).The laser resection group and green laser enucleation group presented with significant decreases in RUV,IPSS score,and QOL score(P<0.05),and a significantly decrease in Qmax compared to the plasma resection group at 1 month and 3 months after surgery(P<0.05).However,the laser resection group and the green laser enucleation group had no statistically signifi⁃cant difference in RUV,IPSS score,Qmax,and QOL score at 1 month and 3 months after surgery(P>0.05).The green laser enucleation group had the lowest total incidence of postoperative complications,following by the laser resection group and plasma resection group in order(7.14%vs.21.74%vs.35.80%,P<0.05).Conclusion The three surgical procedures all have good therapeutic effects on benign prostatic hyperplasia.Transurethral laser prostatectomy and green laser enucleation have superiority to those of transurethral plasma resection of the prostate in efficacy and safety,and they can promote early recovery of patients.Transurethral green laser enucleation is the best in safety.