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中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 387 -391. doi: 10.3877/cma.j.issn.1674-3253.2019.06.007

所属专题: 文献

临床研究

半导体激光选择性增生腺体块状切除术与电切术治疗前列腺增生的比较
王伟1, 潘铁军1, 高磊1, 齐永1,(), 李功成1   
  1. 1. 430070 武汉,南方医科大学武汉临床医学院,中国人民解放军中部战区总医院泌尿外科
  • 收稿日期:2019-07-07 出版日期:2019-12-01
  • 通信作者: 齐永
  • 基金资助:
    湖北省卫生健康委科研基金资助(WJ2019H095)

Comparative study of the safety and efficacy between the 1 470 nm laser resection of the prostate-selective massive and transurethral resection of the prostate in the treatment of benign prostatic hyperplasia

Wei Wang1, Tiejun Pan1, Lei Gao1, Yong Qi1,(), Gongcheng Li1   

  1. 1. Department of Urology, Central War Zone General Hospital of Chinese People's Liberation Army, Wuhan 430070, China
  • Received:2019-07-07 Published:2019-12-01
  • Corresponding author: Yong Qi
  • About author:
    Corresponding author: Qi Yong, Email:
引用本文:

王伟, 潘铁军, 高磊, 齐永, 李功成. 半导体激光选择性增生腺体块状切除术与电切术治疗前列腺增生的比较[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(06): 387-391.

Wei Wang, Tiejun Pan, Lei Gao, Yong Qi, Gongcheng Li. Comparative study of the safety and efficacy between the 1 470 nm laser resection of the prostate-selective massive and transurethral resection of the prostate in the treatment of benign prostatic hyperplasia[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(06): 387-391.

目的

比较1 470 nm激光选择性前列腺增生腺体块状切除术(LRP-SM)与经尿道前列腺电切术(TURP)治疗前列腺增生(BPH)的疗效和安全性。

方法

回顾性分析2018年2月至2019年2月我科收治的98例BPH患者,52例行LRP-SM,46例行TURP。记录两组患者的手术时间、血红蛋白下降值、膀胱持续冲洗时间、留置导尿管时间、住院时间及术后并发症等。评估术前及术后3个月国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Qmax)等。

结果

LRP-SM组与TURP组的手术时间[(42.2±16.3)min vs(58.4±18.2)min]、术后血红蛋白下降值[(2.4±0.8)g/L vs (4.5±1.6)g/L]、膀胱持续冲洗时间[(1.5±0.2)d vs (2.4±0.3)d]、留置导尿管时间[(2.4±0.3)d vs (4.6±2.4)d]、住院时间[(5.3±1.1)dvs (7.6±1.4)d]比较差异均有统计学意义(P<0.05);两组术后3个月IPSS、QOL、PVR及Qmax显著优于术前(P<0.05),但两组间比较差异无统计学意义(P>0.05)。TURP组2例因术后出血予以输血治疗,LRP-SM组无输血病例。TURP组3例和LRP-SM组1例有不同程度短暂性尿失禁,随访术后1~3月恢复正常。TURP组术后有1例尿道狭窄或膀胱颈挛缩需要再次行手术治疗,LRP-SM组无尿道狭窄或膀胱颈挛缩病例。TURP组16例和LRP-SM组4例有逆行射精。LRP-SM组并发症较少,差异有统计学意义(P<0.05)。

结论

LRP-SM和TURP治疗BPH效果相当,但与TURP比较,LRP-SM具有出血风险少、恢复快、并发症发生率较低等优势,特别适合高龄、高危以及对性功能有需求的患者。

Objective

To compare the safety and efficacy of the two surgical approaches, 1 470 nm laser resection of the prostate-selective massive (LRP-SM) versus transurethral resection of the prostate (TURP), in the treatment of benign prostatic hyperplasia (BPH).

Methods

From February 2018 to February 2019, 98 cases of BPH were enrolled, 52 cases underwent LRP-SM, while 46 cases were treated by TURP. The operative time, hemoglobin, duration of postoperative bladder irrigation, indwelling catheterization time, hospital stay and the postoperative complications were recorded. The international prostate symptoms score (IPSS), quality of life (QOL), post-voiding residual urine (PVR), maximum urine flow rate (Qmax) were also compared.

Results

Patients in the LRP-SM group displayed shorter operative time [(42.2±16.3) min vs (58.4±18.2) min, P<0.05], lower risk of haemorrhage, Haemoglobin decrease [(2.4±0.8) g/L vs (4.5±1.6) g/L, P<0.05], shorter bladder irrigation [(1.5±0.2) d vs (2.4±0.3) d, P<0.05] and shorter catheter indwelling [(2.4±0.3) d vs (4.6±2.4) d, P<0.05], as well as shorter hospital stays [(5.3±1.1) d vs (7.6±1.4) d, P<0.05]. The IPSS, QOL, PVR and Qmax were significantly improved after 3 months postoperatively in both groups (P<0.05), but there were no significant differences between the two groups (P>0.05). 2 cases required blood transfusion in the TURP group after operation while none in the LRP-SM group. The incontinence presented in both groups (3 patients in the TURP group and 1 in the LRP-SM group), but all recovered within 1-3 months. Re-operations due to the urethral stricture and bladder neck contracture were needed in 1 case in the TURP group while none in the LRP-SM group. Etrograde ejaculation was reported in 16 cases of the TURP group and 4 cases in the LRP-SM group. Perioperative complications were fewer in the LRP-SM group (P<0.05).

Conclusions

LRP-SM is an excellent treatment for BPH as well as TURP. However, compared with TURP, LRP-SM has the advantages of less risk of bleeding, rapid recovery, and lower incidence of complications, and it is especially suitable for patients with advanced age, high risk and sexual function needed.

表1 LRP-SM组与TURP组术前各项指标比较(±s
视频1 激光前列腺增生腺体块状切除
表2 LRP-SM组与TURP组围手术期各项指标比较(±s
表3 LRP-SM组与TURP组术后3个月随访指标比较(±s
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