选择性半导体激光前列腺气化术治疗前列腺增生的近远期疗效

目的比较前列腺增生(benign prostatic hyperplasia, BPH)患者行选择性半导体激光前列腺气化术(transurethral semiconductor laser vaporization of the prostate, TUDLVP)、经尿道前列腺电切术(transurethral resection of the prostate, TURP)治疗的近远期疗效和安全性。方法 150例BPH患者,根据手术方式分为激光组72例和电切组78例,分别行TUDLVP和TURP。记录2组手术时间、术中失血量、膀胱冲洗时间、留置导尿时间及住院时间;分别于术前及术后1、5年测定残余尿量(residual urine volume, RUV)、最大尿流率(maximum urinary flow rate, Qmax),并行国际前列腺症状评分(International Prostate Symptom Score, IPSS)及生活质量综合评定问卷量表(General Quality of Life Inventory, GQOLI)-74评分;记录术后1、5年并发症发生情况。结果激光组术中失血量(32.35±7.00)mL]较电切组(86.51±20.76)mL]少,膀胱冲洗时间(1.41±0.32)h]、留置导尿时间(1.75±0.35)d]及住院时间(2.16±0.52)d]较电切组(47.93±9.12)h、(3.59±0.81)d、(5.92±1.19)d]短(P<0.05),手术时间(65.73±16.24)min]与电切组(71.00±18.63)min]比较差异无统计学意义(P>0.05)。激光组术后1年继发性出血、短暂性尿失禁、膀胱痉挛、电切综合征发生率(0、4.17%、2.78%、1.39%)低于电切组(6.41%、14.10%、11.54%、8.97%)(P<0.05),术后5年膀胱痉挛、电切综合征发生率(1.39%、0)低于电切组(8.97%、6.41%)(P<0.05)。激光组术前RUV(113.86±25.00)mL]、Qmax(7.02±1.37)mL/s]、IPSS评分(22.56±4.36)分]及GQOLI-74评分(44.79±10.92)分]与电切组(114.10±26.98)mL、(7.06±1.94)mL/s、(22.28±4.15)分、(45.41±10.89)分]比较差异无统计学意义(P>0.05);术后1年,激光组、电切组RUV(25.30±3.25)、(27.29±3.63)mL]较术前减少,IPSS评分(5.41±1.05)、(7.75±1.49)分]较术前降低,Qmax(18.61±2.27)、(16.83±2.15)mL/s]、GQOLI-74评分(75.00±12.07)、(69.63±11.84)分]较术前增高(P<0.05);术后5年,激光组、电切组RUV(26.00±3.88)、(27.20±4.29)mL]较术前减少,IPSS评分(10.67±2.36)、(10.26±2.43)分]较术前降低,Qmax(16.09±2.20)、(15.73±2.75)mL/s]、GQOLI-74评分(74.84±18.43)、(67.88±12.36)分]较术前增高(P<0.05)。激光组术后1年RUV、IPSS评分低于电切组,Qmax、GQOLI-74评分高于电切组(P<0.05);术后5年GQOLI-74评分明显高于电切组(P<0.05),RUV、Qmax、IPSS评分与电切组比较差异无统计学意义(P>0.05)。结论 BPH患者行TUDLVP治疗的近期效果优于TURP,远期疗效与TURP相近。

Short- and long-term curative effect of transurethral semiconductor laser vaporization of the prostate on benign prostatic hyperplasia

Objective To compare the short-and long-term curative effects of transurethral semiconductor laser vaporization of the prostate(TUDLVP) and transurethral resection of the prostate(TURP) on benign prostatic hyperplasia(BPH) and their securities. Methods Totally 150 BPH patients were divided into TUDLVP group(n=72) and TURP group(n=78), receiving TUDLVP and TURP, respectively. The operation lasting time, intraoperative blood loss, bladder flushing time, catheter indwelling time and hospitalization stay were recorded in two groups. The residual urine volume(RUV) and the maximum urinary flow rate(Qmax) were detected, and the International Prostate Symptom Score(IPSS) and the General Quality of Life Inventory-74(GQOLI-74) were evaluated before, as well as 1 and 5 years after operation.The complications 1 and 5 years after operation were recorded.Results The intraoperative blood loss((32.35±7.00)mL)in TUDLVP group was less than that in TURP group((86.51±20.76)mL),the bladder flushing time((1.41±0.32)h),the catheter indwelling time((1.75±0.35)d)and hospitalization stay((2.16±0.52)d)were shorter in TUDLVP group than those in TURP group((47.93±9.12)h,(3.59±0.81)d,(5.92±1.19)d)(P<0.05),and the operation lasting time showed no significant difference between TUDLVP group((65.73±16.24)min)and TURP group((71.00±18.63)min)(P>0.05).The incidences of secondary bleeding,transient urinary incontinence,bladder spasm and the incidence of transurethral resection syndrome were lower in TUDLVP group(0,4.17%,2.78%,1.39%)than those in TURP group(6.41%,14.10%,11.54%,8.97%)1 year after operation(P<0.05),and the incidences of bladder spasm and transurethral resection syndrome were lower in TUDLVP group(1.39%,0)than those in TURP group(8.97%,6.41%)5 years after operation(P<0.05).RUVs((113.86±25.00)mL),Qmax((7.02±1.37)mL/s),IPSS score(22.56±4.36)and GQOLI-74 score(44.79±10.92)in TUDLVP group showed no significant differences compared with those in TURP group((114.10±26.98)mL,(7.06±1.94)mL/s,22.28±4.15,45.41±10.89)before operation(P>0.05).Both in TUDLVP group and TURP group,RUVs((25.30±3.25),(27.29±3.63)mL)were less,IPSS scores(5.41±1.05,7.75±1.49)were lower,Qmax scores((18.61±2.27),(16.83±2.15)mL/s)and GQOLI-74 scores(75.00±12.07,69.63±11.84)were higher 1 year after operation compared with those before operation(P<0.05);RUVs((26.00±3.88),(27.20±4.29)mL)were less,IPSS scores(10.67±2.36,10.26±2.43),Qmax scores((16.09±2.20),(15.73±2.75)mL/s)and GQOLI-74 scores(74.84±18.43,67.88±12.36)were higher 5 years after operation compared with those before operation(P<0.05).RUVs and IPSS scores in TUDLVP group were lower,and Qmax and GQOLI-74 scores were higher than those in TURP group 1 year after operation(P<0.05).GQOLI-74 score was significantly higher in TUDLVP group than that in TURP group,while RUV,Qmax and IPSS scores showed no significant differences between two groups 5 years after operation(P>0.05).Conclusion The short-term curative effect of TUDLVP on BPH is better than that of TURP,but their long-term effects are similar.