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中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 496 -500. doi: 10.3877/cma.j.issn.1674-3253.2022.06.003

临床研究

低功率钬激光与等离子剜除治疗中等体积前列腺增生的比较
顾志波1, 苏倩1, 陈建刚1, 陆明1,†()   
  1. 1. 226200　南通，江苏省南通市第一人民医院，南通大学第二附属医院泌尿外科
  • 收稿日期:2021-11-03 出版日期:2022-12-01
  • 通信作者: 陆明
  • 基金资助:
    南通市科技局指导项目(MSZ19135)

Comparison of low-power holmium laser enucleation and plamakinetic resection of prostate in the treatment of moderate volume benign prostatic hyperplasia

Zhibo Gu1, qian Su1, Jiangang Chen1, Ming Lu1,†()   

  1. 1. Department of Urology, Nantong No.1 People's Hospital, the Second Affiliated Hospital of Nantong University, Jiangsu 226200, China
  • Received:2021-11-03 Published:2022-12-01
  • Corresponding author: Ming Lu
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引用本文：

顾志波, 苏倩, 陈建刚, 陆明. 低功率钬激光与等离子剜除治疗中等体积前列腺增生的比较[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(06): 496-500.

Zhibo Gu, qian Su, Jiangang Chen, Ming Lu. Comparison of low-power holmium laser enucleation and plamakinetic resection of prostate in the treatment of moderate volume benign prostatic hyperplasia[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(06): 496-500.

目的

对中等体积前列腺增生，通过比较低功率钬激光（LP-HoLEP）与等离子剜除（PKEP）的临床疗效，探讨低功率钬激光剜除前列腺增生的临床特点。

方法

收集我院自2018年6月至2020年6月104例前列腺增生（30 ml<V<80 ml）患者，其中LP-HoLEP组51例，PKEP组53例。统计围手术期患者年龄、血红蛋白（Hb）、前列腺体积V1、IPSS、Qmax、RUV、PSA、剜除时间、粉碎时间、膀胱冲洗时间、术后尿管留置时间、住院时间、切除腺体质量、血红蛋白下降量等。统计两组患者术前及术后7 d、14 d及21 d尿白细胞升高例数，及术后6个月的IPSS评分、PSA、前列腺体积V2等。

结果

两组患者年龄、Hb、V1、IPSS、Qmax、RUV、PSA、剜除时间、粉碎时间、腺体切除质量、血红蛋白下降值差异无统计学意义。LP-HoLEP组与PKEP组膀胱冲洗时间为（42.63±13.25）min和（51.67±11.65）min，术后尿管留置时间为（1.80±0.56） d和（2.23±0.83）d，术后平均住院天数为（2.90±0.70）d和（3.58±0.68）d，差异有统计学意义。两组患者尿白细胞升高例数随时间发生趋势性变化（F=132.842，P<0.05），两组患者术后尿白细胞增多差异无统计学意义，（F=1.960，P=0.183）。随访6个月，LP-HoLEP和PKEP组IPSS评分降至（5.23±1.67）和（5.70±1.89），PSA降至（1.17±0.40）和（1.04±0.37）ng/dl，前列腺体积V2降至（15.93±2.18）ml和（15.25±2.73） ml。两组尿失禁和尿道狭窄等并发症发生率差异无统计学意义。

结论

随访6个月，两组均能够有效剜除前列腺且降低PSA，同时改善LUTS，说明对治疗中等体积BPH均安全有效。LP-HoLEP虽然学习曲线较长，但可以减少膀胱冲洗、尿管留置及住院时间。因此，低功率钬激光剜除中等体积前列腺增生具有可行性且可进一步推广应用。

关键词: 前列腺增生, 等离子, 低功率, 钬激光, 前列腺切除术
Objective

To compare the efficacy and safety of low-power holmium laser enucleation (LP-HoLEP) and plamakinetic resection of prostate (PKEP) in treatment of patients with median volume of BPH.

Methods

104 patients with median volume BPH (30 ml<V<80 ml) and underwent LP-HoLEP (n=51) or PKEP (n=53) between June 2018 and June 2020 in our hospital were analyzed. All patients were followed up for 6 months. The age, Hb, V1, RUV, IPSS score, Qmax, PSA, time of enucleation, morcellaction, bladder irrigation, indwelling catheter, hospital stay, weigh of excised gland and decrease of postoperative hemoglobin were comparatively analyzed. The increase number of cases of urinary leukocytes before and 7 d, 14 d and 21 d after surgey, and IPSS score, PSA and V2 at 6 months after surgey in two groups were statistically analyzed.

Results

There was no significant difference in preoperative data, included age, Hb, prostate volume, IPSS, Qmax, PSA and RUV between two groups (P>0.05). There was also no significant difference in enucleation and comminution time, weigh of excised gland, and decrease of hemoglobin between the two groups (P>0.05). However, LP-HoLEP was significantly superior to PKEP in terms of bladder irrigation time [(42.63±13.25) min vs (51.67±11.65) min] and indwelling catheter time [(1.80±0.56) d vs (2.23±0.83) d]. It can also reduce slightly hospital stay [(2.90±0.70) d vs (3.58±0.68) d], P<0.05. The increase number of cases urinary leukocytes changed with time before and 7 d, 14 d and 21 days after operation (F=132.842, P<0.05). And there was no significant difference in urinary leukocytosis between the two methods. The results were significantly improved compared with preoperative IPSS, PSA and postoperative prostate volume (P<0.05), but there was no statistical difference in complications include urinary incontinence, urinary tract infection, retrograde ejaculation and urethral stricture and so on during 6 months follow-up.

Conclusion

LP-HoLEP and PKEP can effectively enucleate the prostate and significantly improve the patient's LUTS symptom during 6-month follow-up. Both procedures reduced the patient's IPSS and PSA but showed no significant difference. LP-HoLEP and PKEP are significant effective and safe in moderate BPH. LP-HoLEP group had a slightly shorter indwelling catheter time, hospital stay and less flush fluid volume despite longer learning curve. In conclusion, LP-HoLEP is as well technically feasible, safe and as it can be further promoted.

Key words: BPH, HoLEP, PKEP, Low Power, Resection of prostate
图1 BHP患者入组流程图
图2 两组30~80 ml前列腺体积的BPH患者术后IPSS，PSA，V2比较注：V2指患者术后前列腺体积
表1 两组30~80 ml前列腺体积的BPH患者围手术期一般资料的比较(±s)
组别 例数 年龄(岁) Qmax(ml/s) IPSS(分) RUV(ml) Hb(g/L) PSA(ng/ml) V1(ml)
LP-HoLEP组 51 68.80±5.97 9.14±1.96 21.33±5.28 60.85±23.54 128.90±8.56 3.19±0.91 60.90±10.21
PKEP组 53 67.08±5.41 9.38±1.62 21.93±3.59 63.80±17.05 126.73±9.45 2.91±0.83 63.08±8.17
t值 1.354 -0.213 -0.025 0.149 1.079 1.465 -1.052
P值 0.180 0.832 0.980 0.523 0.284 0.147 0.296
组别 剜除时间(min) 粉碎时间(min) 膀胱冲洗时间(h) 尿管留置(d) 术后住院(d) 切除质量(g) Hb下降值(g/L)
LP-HoLEP组 50.40±10.91 12.00±3.11 42.63±13.25 1.80±0.56 2.90±0.70 45.85±9.02 7.08±2.38
PKEP组 53.05±8.71 12.95±3.17 51.67±11.65 2.23±0.83 3.58±0.68 42.55±8.41 7.35±1.76
t值 -1.20 -1.352 -3.631 -3.584 -4.361 1.576 -0.694
P值 0.234 0.180 0.001 0.009 0.001 0.119 0.490
表2 两组30~80 ml前列腺体积的BPH患者并发症的比较[例(%)]
组别 例数 近期并发症 远期并发症
二次出血 压力尿失禁 膀胱痉挛 逆行射精 尿道狭窄 复发 二次手术 膀胱颈挛缩
LP-HoLEP组 51 5（9.8） 8（15.7） 7（13.7） 6（11.7） 2（4.7） 0 3（5.9） 1（2.0）
PKEP组 53 7（13.2） 6（11.2） 9（16.9） 8（15.1） 1（1.9） 0 2（3.8） 0
χ2值 0.295 0.425 0.212 0.331 0.001 - 0.002 -
P值 0.587 0.514 0.646 0.565 0.973 - 0.965 -
表3 两组30~80 ml前列腺体积的BPH患者尿白细胞升高例数比较[例(%)]
组别 例数 术前 7 d 14 d 21 d
LP-HoLEP组 51 7(13.7) 43(84.3) 13(25.4) 7(13.2)
PKEP组 53 9(17.0) 37(69.8) 10(18.9) 5(9.8)
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