摘要
目的:对比分析单平面和双平面经尿道钬激光前列腺剜除术(HoLEP)治疗大体积良性前列腺增生(BPH)的临床疗效及安全性。方法:回顾性分析2017年6月至2018年12月江苏大学附属金坛医院泌尿外科67例大体积BPH患者的临床资料,根据HoLEP手术方法分为两组,单平面组30例患者采用精阜旁“5,7”点切开暴露外科包膜层面,双平面组37例患者采用膀胱颈“12”点切开寻找外科包膜层面,比较两组患者围手术期一般资料,记录不良事件及术后随访结果等指标。结果:两组患者在年龄、病程时间、前列腺体积、术前残余尿量(PVR)、术前最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、血清前列腺特异性抗原(PSA)和生活质量评分(QOL)等无统计学差异。双平面组和单平面组的手术时间、剜除组织时间和术中血红蛋白下降分别为(97.65±34.72)min vs(125.46±47.58)min,P<0.01,(60.34±23.45)min vs(97.43±35.51)min,P<0.01,(14.58±12.11)g vs 21.44±11.28g,P<0.01,具有显著性差异。术中不良事件、切除组织体积、膀胱冲洗时间及术后住院时间等资料差异均无统计学意义。术后随访结果表明,两组患者术后短暂性尿失禁的发生率无明显统计学差异,PVR、Qmax、IPSS、QOL均较术前有明显改善,但改善程度两组间无显著差异。结论:HoLEP治疗大体积BPH疗效确切,双平面HoLEP具有视野清晰、手术时间短、出血量少等优点,在前列腺增生组织剥离上更具有优势。
Objective:To compare the clinical effect and safety of monoplane holmium laser enucleation of the prostate(MPHoLEP)from those of biplane HoLEP(BP-HoLEP)in the treatment of large-volume BPH.Methods:We retrospectively analyzed the clinical data on 67 cases of large-volume BPH treated in Jintan People's Hospital from June 2017 to December 2018,30 by MP-Ho-LEP with incisions at 5-and 7-o'clock positions beside the verumontanum and the other 37 by BP-HoLEP with incision at 12 o'clock in the bladder neck to expose the surgical capsule layer.We compared the perioperative,postoperative and follow-up data between the two groups of patients.Results:There were no statistically significant differences between the two groups of patients in the age,disease course,prostate volume or preoperative post-void residual urine volume(PVR),maximum urine flow rate(Qmax),IPSS,PSA level and quality of life score(QOL).Compared with the patients in the MP-HoLEP group,those treated by BP-HoLEP showed a significantly shorter operation time([97.65±34.72]vs[125.46±47.58]min,P<0.01)and tissue-enucleation time([60.34±23.45]vs[97.43±35.51]min,P<0.01)and lower intraoperative level of hemoglobin([14.58±1.11]vs[21.44±1.28]g,P<0.01).Statistically significant differences were not observed in the intraoperative adverse events,volume of the resected tissue,time of bladder irrigation or length of postoperative hospital stay,nor in the incidence of transient urinary incontinence(33%vs36.8%,P>0.05).PVR,Qmax,IPSS and QOL were improved similarly in both of the groups at 6 months postoperatively.Conclusion:Both MP-HoLEP and BP-HoLEP are definitely effective for the treated of large-volume BPH,but the latter is superior to the former for shorter operation and enucleation time and less bleeding.
作者
王荣
许斌
黄伟华
许云华
WANG Rong;XU Bin;HUANG Wei-hua;XU Yun-hua(Department of Urology,Jintan People's Hospital Affiliated to Jiangsu University,Jintan,Jiangsu 213200,China;Department of Urology,Zhongda Hospital of Southeast University,Nanjing,Jiangsu 210009,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2020年第3期242-249,共8页
National Journal of Andrology
基金
国家自然科学基金(81872089)。
关键词
钬激光剜除
良性前列腺增生
单平面
双平面
临床疗效
transurethral holmium laser enucleation of the prostate
large-volume benign prostatic hyperplasia
monoplane
biplane
clinical effect
