四种经尿道前列腺剜除术的疗效和安全性比较

目的比较不同手术治疗良性前列腺增生症(BPH)的有效性和安全性。方法回顾性分析2018年1月至2019年7月入住空军军医大学唐都医院的277例手术治疗的BPH患者的临床资料。其中第二代半导体红激光前列腺剜除(DiLEP)手术组88例,钬激光前列腺剜除(HoLEP)手术组50例,经尿道前列腺等离子双极电切剜除术(PKEP)手术组85例,铥激光前列腺剜除(THuVEP)手术组54例,比较4组手术病例手术时间、术后血红蛋白下降值、术后最大尿流率(Qmax)改善值、术后并发症、手术后国际前列腺症状评分(IPSS)改善等参数,分析4种手术方法的疗效与安全性。结果手术均获成功,HoLEP、DiLEP、PKEP、THuVEP4组患者年龄分别为(68.84±6.28)、(70.94±6.14)、(70.31±7.33)、(70.37±5.87)岁,前列腺体积分别为(61.85±16.51)、(61.23±17.37)、(58.40±17.04)、(63.82±19.68)mL,差异均无显著性统计学意义(P>0.05);而手术时间[(94.24±39.13)、(93.67±50.31)、(117.25±62.99)、(97.46±40.62)min]、血红蛋白下降值[(8.40±5.18)、(9.80±5.22)、(11.89±8.18)、(10.48±4.39)g/L]、IPSS评分改善值[(13.14±5.43)、(13.42±3.93)、(11.38±4.55)、(12.20±4.56)分]以及最大尿流率(Qmax)改善值[(17.42±4.87)、(14.89±2.69)、(14.58±4.76)、(15.17±3.08)mL/s],4项指标差异均有显著性统计学意义(P<0.05)。结论与PKEP相比,HoLEP与DiLEP手术时间短、术中止血效果好、术后前列腺症状改善明显;THuVEP手术时间短;DiLEP尿失禁发生率较低,具有良好的安全性。

Comparative analysis of the efficacy and safety of multiple surgical methods for transurethral enucleation of the prostate

Objective To compare the efficacy and safety of different surgical procedures in the treatment of benign prostatic hyperplasia(BPH).Methods Clinical date of 277 BPH cases treated with surgery during Jan.2018 and July 2019 were retrospectively reviewed,including 80 cases treated with second generation 980nm diode laser enucleation of the prostate(DiLEP group),50 cases treated with holmium laser enucleation of the prostate(HoLEP group),85 cases treated with plasmakinetic enucleation of the prostate(PKEP group),and54 cases treated with thulium:YAG laser vapoenucleation of the prostate(THuVEP group).The mean operation time,hemoglobin reduction during operation,improvement of postoperative maximal urine flow rate(Qmax),incidence of complications and improvement of International Prostate Symptom Score(IPSS)were compared to analyze the curative effect and safety of four kinds of operation.Results All operations were successful.There were no significant differences in age[(68.84±6.28),(70.94±6.14),(70.31±7.33),(70.37±5.87)y]and prostate volume[(61.85±16.51),(61.23±17.37),(58.40±17.04),(63.82±19.68)mL]among DiLEP,HoLEP,PKEP and THuVEP groups(P>0.05).There were significant differences in mean operation time[(94.24±39.13),(93.67±50.31),(117.25±62.99),(97.46±40.62)min],hemoglobin reduction[(8.40±5.18),(9.80±5.22),(11.89±8.18),(10.48±4.39)g/L],improvement of postoperative Qmax[(17.42±4.87),(14.89±2.69),(14.58±4.76),(15.17±3.08)mL/s]and improvement of IPSS[(13.14±5.43),(13.42±3.93),(11.38±4.55),(12.20±4.56)points](P<0.05)among the four groups.Conclusion Compared with PKEP,HoLEP and DiLEP have shorter operation time,better hemostatic effect,and obvious improvement of prostate symptoms.THuVEP has shorter operation time and DiLEP has low incidence of urinary incontinence.All of the four surgical procedures are effective and safe.