低功率钬激光与等离子剜除治疗中等体积前列腺增生的比较

目的对中等体积前列腺增生，通过比较低功率钬激光（LP-HoLEP）与等离子剜除（PKEP）的临床疗效，探讨低功率钬激光剜除前列腺增生的临床特点。 方法收集我院自2018年6月至2020年6月104例前列腺增生（30 ml1、IPSS、Q_max、RUV、PSA、剜除时间、粉碎时间、膀胱冲洗时间、术后尿管留置时间、住院时间、切除腺体质量、血红蛋白下降量等。统计两组患者术前及术后7 d、14 d及21 d尿白细胞升高例数，及术后6个月的IPSS评分、PSA、前列腺体积V₂等。 结果两组患者年龄、Hb、V₁、IPSS、Q_max、RUV、PSA、剜除时间、粉碎时间、腺体切除质量、血红蛋白下降值差异无统计学意义。LP-HoLEP组与PKEP组膀胱冲洗时间为（42.63±13.25）min和（51.67±11.65）min，术后尿管留置时间为（1.80±0.56） d和（2.23±0.83）d，术后平均住院天数为（2.90±0.70）d和（3.58±0.68）d，差异有统计学意义。两组患者尿白细胞升高例数随时间发生趋势性变化（F=132.842，P<0.05），两组患者术后尿白细胞增多差异无统计学意义，（F=1.960，P=0.183）。随访6个月，LP-HoLEP和PKEP组IPSS评分降至（5.23±1.67）和（5.70±1.89），PSA降至（1.17±0.40）和（1.04±0.37）ng/dl，前列腺体积V₂降至（15.93±2.18）ml和（15.25±2.73） ml。两组尿失禁和尿道狭窄等并发症发生率差异无统计学意义。 结论随访6个月，两组均能够有效剜除前列腺且降低PSA，同时改善LUTS，说明对治疗中等体积BPH均安全有效。LP-HoLEP虽然学习曲线较长，但可以减少膀胱冲洗、尿管留置及住院时间。因此，低功率钬激光剜除中等体积前列腺增生具有可行性且可进一步推广应用。

Comparison of low-power holmium laser enucleation and plamakinetic resection of prostate in the treatment of moderate volume benign prostatic hyperplasia

ObjectiveTo compare the efficacy and safety of low-power holmium laser enucleation (LP-HoLEP) and plamakinetic resection of prostate (PKEP) in treatment of patients with median volume of BPH. Methods104 patients with median volume BPH (30 ml1, RUV, IPSS score, Q_max, PSA, time of enucleation, morcellaction, bladder irrigation, indwelling catheter, hospital stay, weigh of excised gland and decrease of postoperative hemoglobin were comparatively analyzed. The increase number of cases of urinary leukocytes before and 7 d, 14 d and 21 d after surgey, and IPSS score, PSA and V₂ at 6 months after surgey in two groups were statistically analyzed. ResultsThere was no significant difference in preoperative data, included age, Hb, prostate volume, IPSS, Q_max, PSA and RUV between two groups (P>0.05). There was also no significant difference in enucleation and comminution time, weigh of excised gland, and decrease of hemoglobin between the two groups (P>0.05). However, LP-HoLEP was significantly superior to PKEP in terms of bladder irrigation time (42.63±13.25) min vs (51.67±11.65) min] and indwelling catheter time (1.80±0.56) d vs (2.23±0.83) d]. It can also reduce slightly hospital stay (2.90±0.70) d vs (3.58±0.68) d], P<0.05. The increase number of cases urinary leukocytes changed with time before and 7 d, 14 d and 21 days after operation (F=132.842, P<0.05). And there was no significant difference in urinary leukocytosis between the two methods. The results were significantly improved compared with preoperative IPSS, PSA and postoperative prostate volume (P<0.05), but there was no statistical difference in complications include urinary incontinence, urinary tract infection, retrograde ejaculation and urethral stricture and so on during 6 months follow-up. ConclusionLP-HoLEP and PKEP can effectively enucleate the prostate and significantly improve the patient's LUTS symptom during 6-month follow-up. Both procedures reduced the patient's IPSS and PSA but showed no significant difference. LP-HoLEP and PKEP are significant effective and safe in moderate BPH. LP-HoLEP group had a slightly shorter indwelling catheter time, hospital stay and less flush fluid volume despite longer learning curve. In conclusion, LP-HoLEP is as well technically feasible, safe and as it can be further promoted.