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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 44 -49. doi: 10.3877/cma.j.issn.1674-3253.2023.01.010

临床研究

等离子电切术与钬激光剜除术治疗体积>80 ml前列腺增生的比较
游猛1, 顾志文1,†(), 宋生生1, 张贺庆1, 詹河涓1   
  1. 1. 528031　广东，佛山市复星禅诚医院泌尿外科
  • 收稿日期:2022-09-21 出版日期:2023-02-01
  • 通信作者: 顾志文
  • 基金资助:
    佛山市科技创新项目自筹经费类科技计划项目(1920001001596)

Comparison of transurethral bipolar plasmakinetic prostatectomy and holmium laser enucleation of the prostate for the treatment of large-size benign prostatic hyperplasia: a randomized controlled study

Meng You1, Zhiwen Gu1,†(), Shengsheng Song1, Heqing Zhang1, Hejuan Zhan1   

  1. 1. Department of Urology, Foshan Fosun Chancheng Hospital, Guangdong 528031, China
  • Received:2022-09-21 Published:2023-02-01
  • Corresponding author: Zhiwen Gu
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引用本文：

游猛, 顾志文, 宋生生, 张贺庆, 詹河涓. 等离子电切术与钬激光剜除术治疗体积>80 ml前列腺增生的比较[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(01): 44-49.

Meng You, Zhiwen Gu, Shengsheng Song, Heqing Zhang, Hejuan Zhan. Comparison of transurethral bipolar plasmakinetic prostatectomy and holmium laser enucleation of the prostate for the treatment of large-size benign prostatic hyperplasia: a randomized controlled study[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(01): 44-49.

目的

比较经尿道前列腺等离子双极电切术（TUPKP）与经尿道前列腺钬激光剜除术（HoLEP）治疗体积>80 ml前列腺增生（BPH）的安全性及疗效。

方法

纳入佛山复星禅诚医院泌尿外科2017年1月至2021年1月收治的80例前列腺体积>80 ml的前列腺增生患者，按随机数字法将其分为TUPKP组、HoLEP组，剔除失访病例，两组顺利完成研究的分别有37例、35例，记录两组术前及术后IPSS、QOL、Qmax、RUV、手术时间、术中出血量、术后留置尿管时间、术后住院天数、并发症等。

结果

两组均能一期完成手术，HoLEP组的手术时间、术后留置尿管天数、术后住院天数均明显少于TUPKP组（P<0.05），两组术后膀胱冲洗时间差异无统计学意义（P>0.05）；HoLEP组切除的前列腺组织量多于TUPKP组（P<0.05），但手术出血量少于后者（P<0.05）。两组术后1个月、6个月的IPSS、RUV、QOL较术前显著降低（P<0.05），Qmax较术前明显增高（P<0.05）；TUPKP组术后1个月的IPSS及QOL改善比HoLEP组更为明显（P<0.05），术后6个月两组的IPSS、Qmax、RUV及QOL差异无统计学意义（P>0.05）。两组术中、术后并发症发生率差异无统计学意义（P>0.05）。

结论

HoLEP和TUPKP均可应用于大体积前列腺增生的治疗，两者均安全有效，在处理大体积前列腺时，HoLEP比TUPKP手术效率更高，术中出血量更少，术后留置尿管时间更短，患者能够更早康复出院。

关键词: 前列腺增生, 大体积前列腺, 前列腺切除术, 前瞻性随机对照研究
Objective

To compare the safety and efficacy between transurethral bipolar plasmakinetic prostatectomy (TUPKP) and holmium laser enucleation of the prostate (HoLEP) for the treatment of large-size (>80 ml) BPH.

Methods

In Foshan Fosun Chancheng Hospital, from January 2017 to January 2021, patients of BPH, prostate size >80 ml, were enrolled in this randomised controlled study, which were classified as TUPKP group (37 patients) and HoLEP group (35 patients). IPSS, QOL, Qmax and RUV were assessed preoperatively and postoperatively at 1 and 6 months between the two groups. Operative time, blood loss, catheterization duration, postoperative hospital stay and complications were all recorded.

Results

Surgeries were successfully achieved in one stage in all patients. Perioperative results showed that operative time was significantly shorter in HoLEP group as well as catheterization duration and postoperative hospital stay (P<0.05, respectively), while there was no statistical difference between the two groups in terms of postoperative bladder irrigation. The prostate tissue removed in the HoLEP group was more than that in the TUPKP group (P<0.05), and the blood loss was less in the HoLEP group (P<0.05). The IPSS, RUV and QOL in each group at 1 month and 6 months were significantly lower than those before operation (P<0.05), meanwhile, Qmax of the two groups were significantly higher than those before operation (P<0.05). The improvement of IPSS and QOL were more obvious at 1 month in the HoLEP group (P<0.05, respectively). However, there were no significant difference between the two groups in IPSS, Qmax, RUV and QOL at 6 months (P>0.05). There was no significant difference in the incidence of intraoperative and postoperative complications between the two groups (P>0.05).

Conclusions

HoLEP and TUPKP are both safe and effective for the treatment of large-size benign prostatic hyperplasia. Compared to TUPKP, HoLEP provides a superior operative efficiency and bleeding control, it needs shorter catheterization duration and hospital stay.

Key words: BPH, Large-size prostate, Prostatectomy, Randomized controlled study(RCT)
表1 两组前列腺增生患者术前一般资料比较
组别 例数 年龄[岁，(±s)] 术前导尿[例(%)] 术前合并症[例(%)] 前列腺体积[ml，(±s)] IPSS[分，M(min~max)] Qmax[ml/s，M(min~max)]
TUPKP组 37 73±7 1(2.7) 12(32.4) 105±10 18(13~26) 7.0(0~11.8)
HoLEP组 35 75±6 3(8.6) 13(37.1) 103±11 19(15~26) 7.6(0~13.8)
统计值 t=1.370 χ2=0.327 χ2=0.176 t=0.667 Z=-0.570 Z=-0.964
P值 0.175 0.567 0.675 0.507 0.569 0.335
组别 RUV[ml，M(min~max)] QOL[分，M(min~max)] 膀胱壁厚度[mm，(±s)] 膀胱憩室[例(%)] 膀胱容量[ml，M(min~max)]
TUPKP组 75(10~800) 4(3~6) 3.3±0.3 7(18.9) 318(166~800)
HoLEP组 78(10~850) 5(3~5) 3.4±0.3 6(17.1) 366(89~850)
统计值 Z=-1.037 Z=-0.559 t=-0.626 χ2=0.038 Z=-1.538
P值 0.300 0.576 0.533 0.845 0.124
表2 两组前列腺增生患者术中、术后情况的比较[M(min~max)]
组别 例数 手术时间(min) 切除的前列腺组织(g) 手术出血量(ml) 术后膀胱冲洗时间(h) 术后留置尿管天数(d) 术后住院天数(d)
TUPKP组 37 80(62~120) 66(61~75) 150(116~250) 26(21~38) 5(4~7) 7(5~14)
HoLEP组 35 70(63~126) 68(65~76) 122(80~258) 26(20~42) 3(3~10) 5(4~13)
Z值 -3.189 -2.742 -4.055 -0.238 -6.646 -5.333
P值 0.001 0.006 <0.001 0.812 <0.001 <0.001
表3 两组前列腺增生患者手术疗效相关指标的比较[M(min~max)]
观察指标 组别(例数) 术前① 术后1个月② 术后6个月③ 组内比较 组间比较
Z①-②，P①-② Z①-③，P①-③ 术后1月(Z，P) 术后6月(Z，P)
TUPKP组(n=37) IPSS(分) 18(13 ~ 26) 6(4 ~ 9) 5(4 ~ 9) -5.316，<0.001 -3.315，<0.001 -5.958，<0.001 -0.430，0.667
HoLEP组(n=35) 19(15~26) 8(6~11) 5(4~7) -5.171，<0.001 -5.171，<0.001
TUPKP组(n=37) Qmax(ml/s) 7.0(0 ~ 11.8) 13.9(6.8 ~ 18.3) 14.6(8.8 ~ 18.5) -5.303，<0.001 -5.304，<0.001 -1.093，0.274 -0.524，0.600
HoLEP组(n=35) 7.6(0~13.8) 13.5(11.2~15.6) 14.5(10.1~16.8) -5.160，<0.001 -5.160，<0.001
TUPKP组(n=37) RUV(ml) 75(10 ~ 800) 10(0 ~ 180) 11(0 ~ 89) -5.304，<0.001 -5.228，<0.001 -1.675，0.094 -0.854，0.393
HoLEP组(n=35) 78(10~850) 17(0~90) 13(0~87) -5.159，<0.001 -5.160，<0.001
TUPKP组(n=37) QOL(分) 4(3 ~ 6) 2(0 ~ 5) 1(0 ~ 3) -5.345，<0.001 -5.404，<0.001 -2.752，0.006 -1.867，0.062
HoLEP组(n=35) 5(3~5) 2(1~4) 2(1~3) -5.165，<0.001 -5.232，<0.001
表4 两组前列腺增生患者手术并发症的比较[例(%)]
组别 例数 包膜穿孔 膀胱穿孔 发热 术后尿潴留 术后出血 压力性尿失禁 尿道狭窄
术后1个月 术后6个月
TUPKP组 37 2(5.4) 0(0) 2(5.4) 2(5.4) 1(2.7) 2(5.4) 0(0) 1(2.7)
HoLEP组 35 0(0) 1(2.8) 3(8.6) 0(0) 0(0) 7(20.0) 1(2.8) 0(0)
χ2值 - - 0.004 - - 2.295 - -
P值 0.493 0.486 0.949 0.493 1.000 0.130 0.486 1.000
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