"六步法"大功率侧出绿激光经尿道前列腺解剖性汽化切除术治疗良性前列腺增生的初步疗效

目的探讨应用"六步法"大功率侧出绿激光经尿道前列腺解剖性汽化切除术(VIT)治疗良性前列腺增生(BPH)的疗效及安全性。方法回顾性分析2018年10月至2020年6月海军军医大学附属公利医院应用侧出绿激光治疗的82例BPH患者的临床资料,其中采用"六步法"VIT治疗的患者40例,为VIT组;采用经典选择性前列腺汽化术(PVP)治疗的患者42例,为PVP组。两组患者年龄[(71.1±8.7)岁与(72.1±7.0)岁]、前列腺体积[75.00(68.25,89.00)ml与73.00(63.25,85.00)ml]、最大尿流率(Q_max)[6.20(5.20,8.20)ml/s与5.90(4.75,7.50)ml/s]、膀胱残余尿量(PVR)[74.00(42.50,103.75)ml与67.00(58.00,84.50)ml]、国际前列腺症状评分(IPSS)[(21.2±5.2)分与(21.0±3.9)分]、生活质量评分(QOL)[5(4,6)分与5(4,6)分]、前列腺特异性抗原(PSA)[6.20(4.12,8.43)ng/ml与5.40(3.88,7.13)ng/ml]差异均无统计学意义(P>0.05)。应用180W绿激光设备,VIT组采用标记、去膜、切沟、切除(最大功率180 W)、修整、粉碎的"六步法"手术,PVP组采用80~180 W功率由内而外依次逐层均匀汽化前列腺组织的方法手术。比较两组围手术期指标及并发症情况;比较两组术前与术后3个月患者Q_max、IPSS、QOL、PVR、PSA变化情况。结果VIT组与PVP组手术均顺利完成,无中转经尿道前列腺切除术或开放手术病例。两组手术时间[60.00(50.00,73.75)min与70.00(61.50,80.00)min]差异有统计学意义(P<0.05);术后患者血红蛋白下降量[15.00(10.00,17.75)g/L与16.00(14.00,19.25)g/L]、膀胱冲洗时间[1(1,1)d与1(1,1)d]、留置尿管时间[3(3,3)d与3(3,3)d]及住院时间[4(3,4)d与4(4,4)d]差异均无统计学意义(P>0.05)。所有患者均未输血,无二次出血及非计划二次住院,均无电切综合征、尿道狭窄、尿失禁等严重并发症。术后尿路感染VIT组2例(5.0%),PVP组9例(21.4%),差异有统计学意义(P<0.05),予抗感染治疗后均治愈。术后3个月两组Q_max、IPSS、QOL、PVR、PSA均较术前明显好转,其中术后VIT组与PVP组IPSS[(5.7±2.5)分与(7.5±2.8)分]和PSA[2.65(2.10,3.90)ng/ml与4.00(2.45,4.45)ng/ml]的差异均有统计学意义(P<0.05)。结论应用"六步法"大功率侧出绿激光经尿道VIT治疗BPH,出血量少、手术时间短、PSA下降明显,并发症较少,是一种安全、有效的治疗BPH的微创技术。

Initial application experience of six-step method high power side-emitting greenlight laser transurethral anatomical vapor incision technique for the treatment of benign prostate hyperplasia

Objective To explore the efficacy and safety of transurethral anatomical vapor incision technique of prostate(VIT)with six-step method high power side-emitting greenlight laser in the treatment of benign prostatic hyperplasia(BPH).Methods A retrospective analysis of 82 patients with BPH who used high power side-out green laser in the treatment from October 2018 to June 2020 in Gongli Hospital of Naval Medical University was performed.Among them,40 patients were treated with six-step method VIT,and 42 patients were treated with photoselective vaporization of prostate(PVP).The two groups of patients were compared in age[(71.1±8.7)years vs.(72.1±7.0)years],prostate volume[75(68.25,89.00)ml vs.73(63.25,85.00)ml],and peak urinary flow rate(Q_max)[6.20(5.20,8.20))ml/s vs.5.9(4.75,7.50)ml/s],post-void residual volume(PVR)[74.00(42.50,103.75)ml vs.67.00(58.00,84.50)ml],international prostate symptom score(IPSS)[(21.2±5.2)vs.(21.0±3.9)],quality of life score(QOL)[5(4,6)vs.5(4,6)],prostate specific antigen(PSA)[6.20(4.12,8.43)ng/ml vs.5.40(3.88,7.13)ng/ml].In general,there was no statistical difference(P>0.05).The VIT group adopts the six-step method of marking,removing film,grooving,excision,trimming and crushing.In the PVP group,the prostate tissue was uniformly vaporized layer by layer from the inside to the outside.Perioperative indexes and complications were compared between the two groups.The Q_max,IPSS,QOL,PVR and PSA between the two groups before and 3 months after surgery were compared.Results All patients in the VIT group and PVP group successfully completed the surgery,and there was no case of transfer to TURP or open surgery.The average operation time was[60.00(50.00,73.75)min vs.70.00(50.00,73.75)min](P<0.05).There was no significant difference in the amount of postoperative hemoglobin decline[15.00(10.00,17.75)g/L vs.16.00(14.00,19.25)g/L],average bladder irrigation time[1(1,1)d vs.1(1,1)d],indwelling catheterization time[3(3,3)]d vs.3(3,3)d]and hospitalization time in patients after operation[4(3,4)d vs.4(4,4)d](P>0.05).All patients had no blood transfusion,second bleeding,readmission,TURS,urethral stricture and urinary incontinence.There were 2 cases(5.0%)of postoperative urinary tract infection in the VIT group and 9 cases(21.4%)of postoperative urinary tract infection in the PVP group(P<0.05),and they were cured after anti-inflammatory treatment.Three months after operation,Q_max,IPSS,QOL,PVR and PSA in the two groups were significantly improved compared with preoperatively.Among them,the differences of IPSS[(5.7±2.5)points vs.(7.5±2.8)points]and PSA[2.65(2.10,3.90)ng/ml vs.4.00(2.45,4.45)ng/ml]in the VIT group and PVP group after operation were statistically significant(P<0.05).Conclusions Applying the six-step method high power side-emitting greenlight laser transurethral anatomical VIT to treat BPH,there is less intraoperative and postoperative bleeding,short operation time,significant decrease in PSA,and fewer complications.It is a safe and effective minimally invasive technology for the treatment of BPH.