摘要
目的评估经尿道铥激光前列腺剜除术(transurethral thulium laser enucleation of the prostate,TmLEP)与经尿道铥激光前列腺汽化切除术(transurethral thulium laser vaporesection of the prostate,TmLRP)治疗高危大体积(>80 mL)良性前列腺增生(benign prostatic hyperplasia,BPH)的安全性与有效性。方法回顾性分析2014年4月至2016年6月在我院行铥激光手术治疗的高危大体积BPH患者,共60例,其中30例行TmLEP,30例行TmLRP。术后随访6个月。比较两组患者术前国际前列腺症状评分(intemational prostate symptom score,IPSS)、生活质量评分(quality of life,QoL)、前列腺体积、最大尿流率(maximum urinary flow rate,Q_(max))、残余尿量(postvoidresidualurinevolume,PVR),比较两组手术时间、剜除或切除前列腺质量、留置尿管时间,比较两组术后IPSS、QoL、Q_(max)、PVR、尿控率,观察两组术中、术后常见并发症。结果患者均顺利完成手术。TmLEP组切除腺体质量多于TmLRP组,差异有统计学意义[(67.2±7.7)g比(46.8±6.8)g,P<0.05],在手术时间、术中出血量、膀胱冲洗时间、留置尿管时间方面比较差异无统计学意义(P>0.05);两组患者术后1、3、6月的IPSS、QoL、Q_(max)、PVR较术前均有较大改善,TmLEP组及TmLRP组术后3个月及6个月尿控率(均为100%)与术后1个月时(分别为83.3%,86.7%)相比明显提高,差异有统计学意义(P<0.05);两组患者在术后随访期内发生暂时性尿失禁、泌尿生殖道感染、尿道狭窄等术后并发症方面比较差异无统计学意义(P>0.05)。结论 TmLEP、TmLRP治疗高危大体积BPH均具有良好的安全性和临床疗效。对于高危大体积BPH患者,充分的术前准备和术中及术后严密监测并发症情况是成功治愈的关键。
Objective To evaluate the safety and efficacy of transurethral thulium laser enucleafion of the prostate (TmLEP)and transurethral thulium laser vaporesection of the prostate (TmLRP)in the treatment of high risk and large volume (more than 80mL)benign prostatic hyperplasia (BPH).Methods Clinical data of 60patients with high risk and large volume BPH were analyzed retrospectively.Of the patients,30underwent TmLEP and the others underwent TmLRP.All patients were followed-up 6months.The International Prostate Symptom Score (IPSS),quality of life.(QoL)score, prostate volume ,maximum urinary flow rate (Qmax)and postvoid residual(PVR)before operation were recorded and analyzed.The operation time,weight of resected tissues,catheterization time were compared.The IPSS,QoL,Qmax,PVR and the urinary control rate after operation were analyzed.The major intraoperative and postoperative complications were recorded and evaluated as well.Results All operations were successful.The amount of the resected gland in TmLEP group was more than that in TmLRP group[(67.2±7.7)g VS (46.8±6.8)g,P<0.05].There were no significant differences between two groups in operation time,the amount of blood loss,bladder irrigation time and indwelling catheter time(P>0.05).There were significant improvements in indexes such as IPSS,QoL,Qmax,PVR in the first ,the third or the sixth moth after the operation.The continence rate of TmLEP group and TmLRP group in the third and he sixth moth after the operation (both 100%)significantly increased compared to that of the first moth after the operation (83.3%,86.7%,respectively)(P<0.05). There were no significant differences between two groups in temporary urinary incontinence,urinary tract infection and urethral stricture(P>0.05).Conclusion TmLEP and TmLRP are both effective and safe in the treatment of high risk and large volume BPH,The key to surgical treatment of aged and high risk BPH patients is to strengthen the perioperative management.
作者
伊庆同
张杰
龚旻
陈楚红
胡巍
朱汝健
Yi Qingtong;Zhang Jie;Gong Min;Chen Chuhong;Hu Wei;Zhu Rujian(Department of Urology,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399,China)
出处
《中国男科学杂志》
CAS
CSCD
2018年第4期46-50,共5页
Chinese Journal of Andrology
基金
上海市浦东新区卫生系统学科带头人培养计划(PWRd2014-06)基金资助
关键词
经尿道前列腺切除术
铥激光
前列腺增生
transurethral resection of prostate
thulium laser
prostatic hyperplasia
