钬激光和铥激光在经尿道前列腺剜除术中应用的对比性研究

目的:研究、比较钬激光和铥激光在经尿道前列腺剜除术中的有效性和安全性。方法:将98例BPH患者分为两组,分别采用钬激光(Ho组)或铥激光(Th组)经尿道前列腺剜除术,比较两组患者手术前后IPSS评分、残余尿量、最大尿流率、手术失血量及电解质等指标变化。结果:两组患者年龄、前列腺体积、术前IPSS评分、残余尿量及最大尿流率等指标均无统计学差异(P均>0.05)。Th组手术时间67～145min,平均(84.6±10.2)min,出血量50～240ml,平均(126.5±14.6)ml。术后平均留置尿管时间2.4d。Ho组手术时间46～122min,平均(70.5±7.5)min,术中失血量80～400ml,平均(176.5±14.1)ml,无输血事件。术后平均尿管留置时间2.5d。Ho组手术时间较Th组短(P=0.032),而失血量似大于Th组,但并无统计学差异(P=0.071)。两组患者手术前后血红蛋白、血Na+、渗透压等均无明显差异,无电切综合征者。两组术前IPSS、残余尿、最大尿流率与术后第3个月指标相比,均存在统计学差异(P均<0.05)。各指标同期对比均无统计学差异(P>0.05)。结论:钬激光或铥激光经尿道前列腺剜除术均可有效缓解下尿路梗阻症状(LUTS),其短期效果相当。术中铥激光止血效果确切,但解剖清晰度逊于钬激光。

Comparison of Holmium and Thulium Laser in Transurethral Enucleation of the Prostate

Objective： To investigate and compare the effect and safety of Holmium laser and Thulium laser in transurethral enucleation of the prostate in BPH patients. Methods ： Ninety-eight BPH patients were divided into 2 groups and underwent transurethral enucleatian of the prostate with holmiun laser （Ho group） and thulium laser （Th group） respectively. Comparisons were made between the 2 groups in operation time, bleeding volume, electrolyte, IPSS score, PVR and Qmax. Results ： No statistically significant differences were noted between the 2 groups in age and preoperative prostate volume, IPSS, PVR and Qmax （P 〉 0. 05 ）. The mean operation time was shorter in the Th group （ 84.6 ± 10.2] min） than in the Ho group （ 70.5 ± 7.5] min） （P = 0.032） ; blood loss was less in the former （ 126.5±14.6] ml） than in the latter （ 176.5 ± 14.1 ] ml ） （P = 0. 071 ）, with no blood transfusion necessitated; and the mean times of catheter indwelling were 2.4 d and 2.5 d respectively. There were no significant differences in the levels of hemoglobin and electrolyte before and after operation between the two groups, and no TURP syndrome was observed. IPSS, PVR and Qmax before operation were significantly different from those obtained 3 months after it （P 〈 0.05 ） in both the groups, but none of the indexes exhibited statistically significant differences when compared in the same period （ P 〉 0.05）. Conclusion ： Both holmium and thulium laser transurethral enucleation of the prostate can alleviate LUTS in BPH patients .with similar short-time effectiveness. Thulium is superior to holmiun laser in hemostasis, but inferior to it in anatomical distinctness.