前列腺剜除术中保留精阜近端组织对减少低龄患者术后逆行射精的疗效研究

目的探讨前列腺钬激光剜除术（HoLEP）中保留精阜近端组织对减少低龄患者术后逆行射精的临床疗效。 方法2014年5月至2015年5月间昆明医科大学第二附属医院40例具有性生活及正常射精功能的前列腺增生患者随机分为HoLEP和保留射精功能的HoLEP（EP-HoLEP）两组，各20例，对HoLEP组进行传统的前列腺钬激光剜除术，对EP-HoLEP组进行保留射精功能的前列腺钬激光剜除术，术中保留精阜近端<1 cm范围内的组织及黏膜。记录、分析两组患者术前和术后随访的各项指标。 结果HoLEP组和EP-HoLEP组术前一般情况比较差异无统计学意义（P>0.05），两组均顺利完成手术。术后随访中，两组最大尿流率（Q_max）、残余尿量（PVR）、国际前列腺症状评分（IPSS）和生活质量评分（QOL）均较术前有明显改善（P<0.01）。两组患者术前精液量分别为（3.1±0.6）ml和（3.4±0.7）ml （P>0.05），而术后12个月分别为（1.2±1.3）ml和(2.3±1.5) ml（P<0.05）。HoLEP组术后12个月逆行射精、顺行射精例数分别为15例（75%）、5例（25%）；而EP-HoLEP组分别为8例（40%）、12例（60%），两组间比较差异有统计学意义（P<0.05）。 结论EP-HoLEP可有效减少前列腺增生患者术后逆行射精的比例，在改善排尿症状方面与传统的HoLEP具有相似的临床疗效。

The clinical efficacy of sparing the proximal part of verumontanum for ejaculation preservation in holmium laser enucleation of the prostate

ObjectiveTo explore the effectiveness of sparing the proximal part of verumontanum for ejaculation preservation in holmium laser enucleation of the prostate (HoLEP). MethodsFrom May 2014 to May 2015, 40 sexually active patients with sufficient ejaculate underwent HoLEP. Twenty patients received ejaculation-preserving technique during HoLEP (EP-HoLEP group). The other 20 patients underwent conventional HoLEP (conventional-HoLEP group). In the EP-HoLEP group, the tissue >1 cm proximal to verumontanum was preserved. ResultsThere was no significant difference in patient characteristics and perioperative parameters. Preoperatively, the volume of semen were (3.1±0.6) ml in HoLEP group and (3.4±0.7) ml in EP-HoLEP group (P>0.05); 12 months after surgery, there were (1.2±1.3) ml and (2.3±1.5) ml (P<0.05). Success rate of ejaculation preservation were 25% in HoLEP group and 60% in EP-HoLEP group, oppositely,the rate of retrograde ejaculation were 75% and 40% (P<0.05) respectively. ConclusionsSparing the proximal part of verumontanum in HoLEP could improve the success rate of ejaculation preservation.