“五步法”低功率直出式绿激光前列腺剜除术治疗大体积前列腺增生的疗效及体会

目的　探讨“五步法”低功率直出式绿激光前列腺剜除术（VREP）治疗大体积前列腺增生（BPH）的疗效及安全性。方法　回顾性分析因排尿费力、夜尿增多、尿线较前变细等下尿路症状就诊的71例前列腺增生患者资料，其中38例以“五步法”VREP治疗（VREP组），另33例以经尿道绿激光前列腺汽化术（PVP）治疗（PVP组）。VREP组以定位、切槽、分块、剜除、粉碎的“五步法”方式手术，PVP组以180 W功率逐层均匀汽化整个腺体的方式手术。记录并分析围手术期数据及并发症，比较2组患者术前与术后残余尿体积（PVR）、最大尿流率（Qmax）、前列腺特异性抗原（PSA）、国际前列腺症状评分（IPSS）及生活质量评分（QOL）等指标变化情况。结果　VREP组和PVP组手术均顺利完成，术中无包膜穿孔、水中毒等并发症，2组手术时间分别为［56.00（50.75，59.00）］min和［65.00（57.00，71.50）］ min，VREP组明显优于PVP组（P＜0.01）；术后血红蛋白下降值［17.00（12.00，23.25）g/L和14.00（9.50，20.50）g/L］、留置尿管时间［2.00（2.00，2.00）d和2.00（2.00，2.00）d］及住院时间［3.00（3.00，4.00）d和3.00（3.00，4.00）d］差异均无统计学意义（P＞0.05）；术后3个月复查PVR、Qmax、IPSS、QOL及PSA，其中VREP组PSA［3.08（1.33，5.98）μg/L vs. 5.05（3.05，6.72）μg/L］及IPSS［9.00（7.00，10.00）分 vs. 10.00（9.00，11.50）分］均低于PVP组（P＜0.05）。结论　“五步法”低功率直出式绿激光VREP治疗大体积BPH具有手术时间短、腺体清除效率高、术后恢复快等优势，可视为一种安全有效的手术方法，值得推广。

Efficacy and experience of five-step low power direct- release green laser prostatic enucleation in the treatment of large prostatic hyperplasia

Objective　To explore clinical effectiveness and safety of five-step method-low power end-fire greenlight laser in transurethral vaporresection-enucleation of prostate (VREP) for the treatment of begnin prostatic hyperplasia (BPH). Methods　Data of 71 patients with BPH who received treatment at Binhu Hospital of Hefei from January 2019 to September 2020 were retrospectively analyzed. Among them, 38 patients were treated with five-step method (the VREP group), and the other 33 patients were treated with photoselective vaporization of prostate (the PVP group). In the VREP group, the operation was performed by a five-step method of locating, grooving, dividing, enucleation and crushing, while in the PVP group, the entire gland was uniformly vaporized layer by layer with 180W power. Perioperative data and complications were recorded and analyzed. Changes in IPSS, QOL, Qmax, PVR, PSA and other indicators before and after surgery were compared between the two groups. Results　All patients were successfully operated without capsular perforation, water poisoning and other complications. The average operation time was ［56.00 (50.75, 59.00) min in the VEP group and 65.00 (57.00, 71.50) min］ in the PVP group (P＜0.01). Values of hemoglobin decreased after operation in the VEP group and the PVP group ［17.00 (12.00, 23.25) g/L and 14.00 (9.50, 20.50) g/L］. The time of indwelling catheterization was ［2.00 (2.00, 2.00) d vs. 2.00 (2.00, 2.00) d］for the two groups, and the hospitalization time was［3.00 (3.00, 4.00) d vs. 3.00 (3.00, 4.00) d］ (P＞0.05). PVR, Qmax, IPSS, QOL and PSA improved significantly 3 months after operation. IPSS［9.00 (7.00,10.00) vs. 10.0 (9.00, 11.50)］and PSA ［3.08 (1.33, 5.98) μg/L vs. 5.05 (3.05, 6.72) μg/L］were significant lower in the VREP group than those of the PVP group (P＜0.05). Conclusion　Five-step method low power end-fire greenlight laser VREP treatment of BPH has the advantages of short operation time, higher effective gland clearance rate and fast postoperative recovery, which can be regarded as a safe and effective surgical method and is worth promoting.