经尿道钬激光前列腺剜除术治疗良性前列腺增生的临床应用及评价

目的评价经尿道钬激光前列腺剜除术(HoLEP)治疗良性前列腺增生(BPH)的临床疗效、安全性及并发症。方法回顾性分析97例良性前列腺增生症患者接受HoLEP手术的临床资料,从年龄、手术时间、切除腺体体积、手术出血量及手术前后国际前列腺症状评分表(IPSS)评分、最大尿流率、残余尿量及性功能的变化等方面系统分析。并从中筛选50例患者应用国际勃起功能障碍指数5(IIEF-5)量表调查手术前后勃起功能的变化,并采用RigiScan记录仪进行术前、术后6 d及术后6个月夜间勃起功能(NPT)检测。结果 97例患者年龄53⁸9岁,平均(69.88±8.05)岁,手术时间7089岁,平均(69.88±8.05)岁,手术时间70⁷10 min,平均(179.12±84.89)min,切除腺体体积13.30710 min,平均(179.12±84.89)min,切除腺体体积13.30²07.56 g,平均(73.27±38.00)g,手术出血量50207.56 g,平均(73.27±38.00)g,手术出血量50⁸00 ml,平均(120±23.21)ml,手术前后分别:IPSS评分为(25.2±6.26)分和(8.6±1.34)分,生活质量评分为(5.2±0.53)分和(2.4±0.39)分,最大尿流率(7.56±5.04)ml/s和(23.61±4.62)ml/s,残余尿量(263.04±245.78)ml和(26.47±23.84)ml,其中筛选的50例患者IIEF-5调查问卷显示术前ED发生率为84%,术后6个月勃起功能障碍发生率为78%。结论 HoLEP是治疗BPH有效且安全的微创方法,能够切除较大体积的前列腺,术中、术后出血量少,术后留置尿管时间短,临床症状改善明显并且对BPH患者勃起功能障碍改善有一定作用。

Clinical application and evaluation of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia

Objective To evaluate the clinical efficacy, Safety and complication of the holmium laser enucleation of the prostate （HoLEP） to treat the benign prostatic hyperplasia（BPH）. Methods Use the method of retrospective analysis to analyze 97 cases of BPH patients who received the HoLEP through the aspects of age, operation time, removed prostate size, blood loss, IPSS score before and after the operation, maximum urinary flow rate, residual urine volume and change of sex function. 50 cases were screened from above to apply the IIEF-5 scale form to detect the erectile functions before and after the surgeries. The nocturnal penile tumescence （NPT） was also tracked by the RigiScan recorder at various time points including before surgery, 6 days after surgery and 6 months after surgery. Results The age of patients ranged from 53 to 89 years old （69.88±8.05）. The operation duration was from 70 to 710 rain [（179.12±84.89）rain]. The removed prostate size was from 13.30 to 207.56 g [（73.27±38.00）g]. The loss of blood during operation was from 50 to 800 ml [（120±23.21）ml]. Before the surgery, the IPSS was 25.2±6.26; The scale of the quality of life was 5.2±0.53; The maximum urine flow rate was （7.56±5.04）ml/s; The residual urine volume was （263.04±245.78）ml. The IIEF-5 questionnaires of the 50 screened cases revealed that the incidence of ED before the surgery was 84%. After the surgery, the IPSS was 8.6±1.34; The scale of the quality of life was 2.4±0.39; The maximum urine flow rate was （23.61±4.62）ml/s; The residual urine volume was （26.47±23.84）ml. The IIEF-5 questionnaires of the 50 screened cases showed that the incidence of ED after the surgery was 78%. Conclusion HoLEP is a minimally invasive surgery to treat BPH which is proved to be effective and safe. It could remove relatively large prostate, decrease the blood loss during and after the operation, shorten the duration of indwelling urinary catheter, improve clinical symptomes and the erectile function to some e