ThuLEP与TURP术后发生尿道狭窄的预测模型构建

doi:10.3877/cma.j.issn.1674-3253.2026.05.007

目的

比较经尿道前列腺铥激光剜除组与经尿道前列腺电切组治疗前列腺增生的疗效，并在研究结果上建立两种术式发生尿道狭窄的诺莫预测模型。

方法

回顾性分析174例前列腺增生患者临床资料，观察组（95例）行ThuLEP和对照组（79例）TURP，统计两组患者围术期观察指标，包括手术时间、留置导尿时间、住院时间、住院费用，术后6个月随访观察指标包括国际前列腺症状评分（IPSS）、生活质量评分（QOL）、是否发生尿道狭窄。逻辑回归筛选尿道狭窄的危险因素建立预测模型，通过ROC曲线、模型拟合度曲线、临床决策曲线评估验证模型。

结果

两组患者均顺利完成手术并出院，ThuLEP组与TURP组相比，住院费用、住院天数、手术时间上均较少（P<0.05）。留置尿管时间两组差异无统计学意义（P>0.05）。ThuLEP组与TURP组术后尿道狭窄发生情况差异无统计学意义（P>0.05）。经过多因素分析确定术前国际前列腺症状评分（IPSS）、前列腺大小、手术时间以及尿管安置时间为尿道狭窄发生的独立危险因素，并据此建立了诺莫预测模型。

结论

ThuLEP手术在疗效、医疗费用、手术时间都优于TURP，术前IPSS、前列腺大小、手术时间、安置尿管时间建立的预测模型能较好预测两种术式术后尿道狭窄发生率。

关键词: 前列腺铥激光剜除术, 前列腺电切术, 尿道狭窄, 诺莫预测模型

Objective

To compare the efficacy of transurethral thulium laser enucleation of the prostate (ThuLEP) with transurethral resection of the prostate (TURP), and to develop a nomogram-based prediction model for urethral stricture occurrence based on the outcomes of these two procedures.

Methods

The clinical data of 174 patients with benign prostatic hyperplasia were retrospectively analyzed. The observation group (n=95) underwent ThuLEP, while the control group (n=79) underwent TURP. Perioperative indicators, including operation time, indwelling catheterization duration, hospital stay, and hospitalization cost were collected. At six months postoperatively, the international prostate symptom score (IPSS), quality of life (QOL), and incidence of urethral stricture were assessed. Logistic regression analysis was performed to identify risk factors for urethral stricture, and a predictive nomogram model was established. The model's performance was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve.

Results

Both groups successfully completed their respective surgeries and were discharged without complications. Compared with the TURP group, the ThuLEP group demonstrated less hospitalization cost, shorter hospital stay, and shorter operation time. No significant difference was observed in indwelling catheterization duration between the two groups. Additionally, there was no significant difference in the incidence of postoperative urethral stricture between the ThuLEP and TURP groups. Preoperative IPSS, prostate size, operation time, and catheter placement duration were identified as independent risk factors for urethral stricture, and a nomogram-based prediction model was developed accordingly.

Conclusions

ThuLEP demonstrates superior efficacy compared to TURP, with less medical cost and shorter operation time. Furthermore, a predictive model incorporating preoperative IPSS, prostate size, operation time, and catheter placement duration can effectively estimate the probability of postoperative urethral stricture.

Key words: Thulium laser enucleation of the prostate, Transurethral resection of the prostate, Urethral stricture, Nomogram

表1 术前两组前列腺增生患者基线资料对比(

±s)

指标	例数	年龄(岁)	前列腺体积(cm³)	IPSS评分	QOL评分
TURP组	79	72.01±7.15	117.00±25.04	19.94±4.74	4.86±0.69
ThuLEP组	95	73.49±6.97	115.61±25.35	19.48±4.90	4.80±0.65
t值		-1.378	0.362	0.618	0.594
P值		0.170	0.718	0.538	0.553

表1 术前两组前列腺增生患者基线资料对比(

±s)

指标	例数	年龄(岁)	前列腺体积(cm³)	IPSS评分	QOL评分
TURP组	79	72.01±7.15	117.00±25.04	19.94±4.74	4.86±0.69
ThuLEP组	95	73.49±6.97	115.61±25.35	19.48±4.90	4.80±0.65
t值		-1.378	0.362	0.618	0.594
P值		0.170	0.718	0.538	0.553

表2 前列腺增生患者ThuLEP与TURP治疗效果对比

组别	例数	住院费用[万元，M(Q)]	手术时间[min，(±s)]	尿管留置天数[d，(±s)]	术后IPSS评分[M(Q)]	住院天数[d，(±s)]	术后QOL评分[M(Q)]	尿道狭窄发生率[例（%）]
TURP	79	1.39(1.22，1.67)	97.65±21.28	5.09±0.92	7.0 (4.0，10.0)	11.51±3.68	1.0 (1.0，3.0)	10 (12.7)
ThuLEP	95	1.27(1.14，1.54)	74.93±12.47	5.02±0.91	3.0 (2.0，7.0)	10.45±3.20	0 (0，2.0)	7 (7.4)
统计值		Z=-2.921	t=8.756	t=0.484	Z=-3.348	t=1.993	Z=-3.829	χ²=0.835
P值		0.003	<0.001	0.629	0.001	0.048	<0.001	0.361

表2 前列腺增生患者ThuLEP与TURP治疗效果对比

组别	例数	住院费用[万元，M(Q)]	手术时间[min，(±s)]	尿管留置天数[d，(±s)]	术后IPSS评分[M(Q)]	住院天数[d，(±s)]	术后QOL评分[M(Q)]	尿道狭窄发生率[例（%）]
TURP	79	1.39(1.22，1.67)	97.65±21.28	5.09±0.92	7.0 (4.0，10.0)	11.51±3.68	1.0 (1.0，3.0)	10 (12.7)
ThuLEP	95	1.27(1.14，1.54)	74.93±12.47	5.02±0.91	3.0 (2.0，7.0)	10.45±3.20	0 (0，2.0)	7 (7.4)
统计值		Z=-2.921	t=8.756	t=0.484	Z=-3.348	t=1.993	Z=-3.829	χ²=0.835
P值		0.003	<0.001	0.629	0.001	0.048	<0.001	0.361

图1 预测TURP和ThuLEP术后发生尿道狭窄列线图模型注：为便于风险评分方向统一，采用各因素OR的倒数（1/OR）呈现，OR>1表示该因素水平升高时狭窄发生风险增加

表3 单因素逻辑回归分析TURP和ThuLEP术后发生尿道狭窄的危险因素

变量	类型	数量	OR	95%CI	P值
前列腺大小	数值变量	174	0.953	0.935～0.973	<0.001
手术时间	数值变量	174	0.957	0.935～0.980	<0.001
术前IPSS	数值变量	174	0.822	0.736～0.918	<0.001
留置尿管时间	数值变量	174	0.533	0.318～0.894	0.017

表3 单因素逻辑回归分析TURP和ThuLEP术后发生尿道狭窄的危险因素

变量	类型	数量	OR	95%CI	P值
前列腺大小	数值变量	174	0.953	0.935～0.973	<0.001
手术时间	数值变量	174	0.957	0.935～0.980	<0.001
术前IPSS	数值变量	174	0.822	0.736～0.918	<0.001
留置尿管时间	数值变量	174	0.533	0.318～0.894	0.017

表4 多因素逻辑回归分析TURP和ThuLEP术后发生尿道狭窄的危险因素

变量	系数β	OR	95%CI	P值
前列腺大小	-0.033	0.968	0.945～0.991	0.007
手术时间	-0.032	0.969	0.937～1.002	0.067
术前IPSS	-0.225	0.799	0.687～0.928	0.003
留置尿管时间	-0.761	0.467	0.243～0.897	0.022

表4 多因素逻辑回归分析TURP和ThuLEP术后发生尿道狭窄的危险因素

变量	系数β	OR	95%CI	P值
前列腺大小	-0.033	0.968	0.945～0.991	0.007
手术时间	-0.032	0.969	0.937～1.002	0.067
术前IPSS	-0.225	0.799	0.687～0.928	0.003
留置尿管时间	-0.761	0.467	0.243～0.897	0.022

表5 列线图预测模型的评价结果表

评价方向	评价内容	统计值	P值
模型检验	似然比检验	χ²=43.826	<0.001
区分度评价	C指数	0.903(0.838～0.968)	<0.001
校准度评价	拟合优度检验	χ²=3.556	0.895

表5 列线图预测模型的评价结果表

评价方向	评价内容	统计值	P值
模型检验	似然比检验	χ²=43.826	<0.001
区分度评价	C指数	0.903(0.838～0.968)	<0.001
校准度评价	拟合优度检验	χ²=3.556	0.895

图2 列线图模型预测尿道狭窄的ROC曲线图

图3 列线图预测尿道狭窄模型的校准曲线注：a为加入前列腺大小时的校准曲线；b为未加入前列腺大小的预测模型校准图；AIC，也被称为赤池信息准则，数值越小表示预测模型拟合度越好

图4 列线图预测尿道狭窄模型的决策曲线

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Development of predictive model for urethral stricture after ThuLEP and TURP

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Development of predictive model for urethral stricture after ThuLEP and TURP