直出式绿激光治疗围术期维持口服抗凝药的高龄高危前列腺增生患者的临床观察

doi:10.3877/cma.j.issn.1674-3253.2026.05.010

目的

评估直出式绿激光治疗围术期维持口服抗凝药的高龄高危前列腺增生患者的安全性及临床疗效。

方法

纳入淮北市人民医院泌尿外科2021年9月至2024年9月接收的临床确诊为前列腺增生的高龄患者116例，按围术期是否维持口服抗凝药物将其分为口服抗凝药物组（OA组，n=45）和非抗凝药物组（非OA组，n=71）。观察两组患者手术时间、手术前后血红蛋白变化、膀胱冲洗时间及留置导尿管时间、术后住院时间、术前及术后1个月、3个月、6个月两组患者IPSS、QOL、Q_max、PVR及术后相关并发症发生情况。

结果

两组患者术后并发症发生率分别为17.8%（OA组）及12.7%（非OA组），差异无统计学意义（P>0.05）。OA组手术时间为（68.8±9.5）min，较非OA组（59.2±5.5）min更长，差异有统计学意义（P<0.001）；OA组术后平均膀胱持续冲洗时间（24.8±2.2）h，较非OA组（24.2±2.6）h长，差异无统计学意义（P>0.05）；OA组术后导尿管留置时间（4.7±0.8）d较非OA组（4.5±0.5）d长，差异有统计学意义（P=0.043）；OA组与非OA组手术后血红蛋白平均下降值分别为（9.8±3.4）g/L、（9.3±2.7）g/L，差异无统计学意义（P>0.05）；OA组术后住院时间（5.5±0.7）d，较非OA组（5.3±0.5）d长，但差异无统计学意义（P>0.05）；术后1、3、6个月两组患者IPSS、QOL、Q_max及PVR较术前有明显改善，且差异有统计学意义（P<0.05）；两组间IPSS、QOL、Q_max及PVR差异均无统计学意义（P>0.05）。

结论

直出式绿激光汽化术可能是治疗围术期维持口服抗凝药的高龄高危前列腺增生患者的一种有效、安全的手段。

关键词: 前列腺增生, 直出式绿激光, 抗凝治疗, 光选择性汽化切除

Objective

To evaluate the safety and clinical efficacy of photoselective vaporesection of the prostate treatment in high-risk elderly patients with benign prostatic hyperplasia (BPH) who are on oral anticoagulant therapy during the perioperative period.

Methods

A total of 116 elderly patients clinically diagnosed with benign prostatic hyperplasia who were admitted to Huaibei People's Hospital from September 2021 to September 2024 were included. They were divided into the oral anticoagulant group (OA group, n=45) and the non-anticoagulant group (non-OA group, n=71) based on whether they took oral anticoagulant drugs before the operation. The operation time, pre- and postoperative haemoglobin changes, bladder irrigation time and indwelling catheter time, postoperative hospital stay, IPSS, QOL, Q_max, PVR and postoperative complications at 1, 3 and 6 months before and after operation were observed in the two groups.

Results

The incidence of postoperative complications in the two groups was 17.8% (OA group) and 12.7% (non-OA group), respectively, with no significant difference between the two groups (P>0.05). The operation time in the OA group [(68.8±9.5) min] was longer than that in the non-OA group [(59.2±5.5) min], which was a significant difference (P<0.001). The duration of continuous postoperative bladder irrigation in the OA group [(24.8±2.2) h] was longer than that of the non-OA group [(24.2±2.6) h], with no significant difference (P>0.05). The postoperative catheter retention time in the OA group [(4.7±0.8) d] was longer than that in the non-OA group [(4.5±0.5) d], and the difference was statistically significant (P=0.043). The decrease in haemoglobin in the OA group and the non-OA group after the surgery was (9.8±3.4) g/L and (9.3±2.7)g/L respectively, and the difference between the two groups was not statistically significant (P>0.05). The length of postoperative hospital stay in the OA group [(5.5±0.7) d] was longer than that in the non-OA group [(5.3±0.5) d], and the difference was not statistically significant (P>0.05). The patients in the two groups at 1, 3, and 6 months after the surgery had a significant improvement in the IPSS, QOL, Q_max, and PVR compared with that of preoperative period and the difference was statistically significant (P<0.05), the differences in IPSS, QOL, Q_max and PVR between the two groups were not statistically significant (P>0.05).

Conclusion

Photoselective vaporesection of the prostate may be an effective and safe way for the treatment of perioperative maintenance of oral anticoagulants in elderly patients with high-risk prostatic hyperplasia.

Key words: Benign prostatic hyperplasia, Front-firing greenlight laser, Anticoagulant therapy, Photoselective vaporesection of the prostate

表1 两组前列腺增生（BPH）患者一般资料比较（

±s）

组别	例数	年龄(岁)	BMI (kg/m²)	前列腺体积(mL)	IPSS评分(分)	Q_max (mL/s)	PVR (mL)
OA组	45	79.0±5.6	25.54±3.79	37.7±11.6	25.7±4.2	7.9±2.1	101.2±12.1
非OA组	71	77.9±5.2	26.02±3.43	36.7±10.2	24.6±3.9	8.3±1.8	95.9±16.2
t值		1.122	-0.705	0.505	1.437	1.090	1.886
P值		0.264	0.482	0.614	0.154	0.277	0.062

表1 两组前列腺增生（BPH）患者一般资料比较（

±s）

组别	例数	年龄(岁)	BMI (kg/m²)	前列腺体积(mL)	IPSS评分(分)	Q_max (mL/s)	PVR (mL)
OA组	45	79.0±5.6	25.54±3.79	37.7±11.6	25.7±4.2	7.9±2.1	101.2±12.1
非OA组	71	77.9±5.2	26.02±3.43	36.7±10.2	24.6±3.9	8.3±1.8	95.9±16.2
t值		1.122	-0.705	0.505	1.437	1.090	1.886
P值		0.264	0.482	0.614	0.154	0.277	0.062

表2 两组BPH患者术后并发症发生情况比较（例）

组别	例数	膀胱刺激征	术中大出血	严重血尿致二次手术	短暂性尿失禁	电切综合征	泌尿系感染	包膜穿孔	合计
OA组	45	4	0	0	1	0	3	0	8
非OA组	71	3	0	0	2	0	4	0	9
χ²值									0.573
P值									0.449

表2 两组BPH患者术后并发症发生情况比较（例）

组别	例数	膀胱刺激征	术中大出血	严重血尿致二次手术	短暂性尿失禁	电切综合征	泌尿系感染	包膜穿孔	合计
OA组	45	4	0	0	1	0	3	0	8
非OA组	71	3	0	0	2	0	4	0	9
χ²值									0.573
P值									0.449

表3 两组BPH患者围手术期指标比较（

±s）

组别	例数	手术时间(min)	血红蛋白下降值(g/L)	膀胱冲洗时间(h)	留置导尿管时间(d)	术后住院时间(d)
OA组	45	68.8±9.5	9.8±3.4	24.8±2.2	4.7±0.8	5.5±0.7
非OA组	71	59.2±5.5	9.3±2.7	24.2±2.6	4.5±0.5	5.3±0.5
t值		-5.819	1.045	1.098	2.047	-1.837
P值		<0.001	0.289	0.274	0.043	0.067

表3 两组BPH患者围手术期指标比较（

±s）

组别	例数	手术时间(min)	血红蛋白下降值(g/L)	膀胱冲洗时间(h)	留置导尿管时间(d)	术后住院时间(d)
OA组	45	68.8±9.5	9.8±3.4	24.8±2.2	4.7±0.8	5.5±0.7
非OA组	71	59.2±5.5	9.3±2.7	24.2±2.6	4.5±0.5	5.3±0.5
t值		-5.819	1.045	1.098	2.047	-1.837
P值		<0.001	0.289	0.274	0.043	0.067

表4 两组BPH患者手术前后IPSS、QOL、Q_max及PVR情况（

±s）

时间	术前	术后
时间	术前	1个月	3个月	6个月
IPSS (分)
OA组	25.7±4.2	8.6±2.1^*	9.5±2.1^*	8.5±1.6^*
非OA组	24.6±3.9	8.9±1.6^*	7.9±1.6^*	8.1±1.1^*
QOL (分)
OA组	4(3～5)	2(1～3)^*	1(1～2)^*	1(1～2)^*
非OA组	4(3～5)	2(1～4)^*	1(1～3)^*	1(1～3)^*
Q_max (mL/s)
OA组	7.9±2.1	14.4±4.5^*	15.1±4.8^*	16.2±4.2^*
非OA组	8.3±1.8	14.1±3.1^*	14.6±3.3^*	15.6±5.7^*
PVR (mL)
OA组	101.2±12.1	20.0±2.3^*	18.3±2.4^*	17.0±3.2^*
非OA组	95.9±16.2	20.2±1.2^*	18.0±1.6^*	17.3±1.8^*

表4 两组BPH患者手术前后IPSS、QOL、Q_max及PVR情况（

±s）

时间	术前	术后
时间	术前	1个月	3个月	6个月
IPSS (分)
OA组	25.7±4.2	8.6±2.1^*	9.5±2.1^*	8.5±1.6^*
非OA组	24.6±3.9	8.9±1.6^*	7.9±1.6^*	8.1±1.1^*
QOL (分)
OA组	4(3～5)	2(1～3)^*	1(1～2)^*	1(1～2)^*
非OA组	4(3～5)	2(1～4)^*	1(1～3)^*	1(1～3)^*
Q_max (mL/s)
OA组	7.9±2.1	14.4±4.5^*	15.1±4.8^*	16.2±4.2^*
非OA组	8.3±1.8	14.1±3.1^*	14.6±3.3^*	15.6±5.7^*
PVR (mL)
OA组	101.2±12.1	20.0±2.3^*	18.3±2.4^*	17.0±3.2^*
非OA组	95.9±16.2	20.2±1.2^*	18.0±1.6^*	17.3±1.8^*

[1]	Tamalunas A, Magistro G, Grimm T, et al. Klinik, diagnostik und therapie des benignen prostatasyndroms[J]. MMW Fortschr Der Med, 2019, 161(8): 50-57. DOI: 10.1007/s15006-019-0017-7.
[2]	Tian Q, Zhang X, Luo M, et al. Application of research-based quality control circle in setting a new management model and complete standardized care for continuous bladder irrigation after TURP[J]. Urol Res, 2023, 1(2): 6-14. DOI: 10.26689/ur.v1i2.5460.
[3]	Abdulhamid AK, Khalaf RJ. Safety of not withholding clopidogrel therapy during the immediate several days pre- and post-trans-urethral resection of prostate (TURP): a retrospective cohort study[J]. Int Urol Nephrol, 2022, 54(5): 985-992. DOI: 10.1007/s11255-022-03147-y.
[4]	Liu S, Liu H, Yao H, et al. A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml[J]. Lasers Med Sci, 2023, 38(1): 133. DOI: 10.1007/s10103-023-03794-2.
[5]	Gong YG, Liu RM, Gao R. Photoselective vaporesection of the prostate with a front-firing lithium triborate laser: surgical technique and experience after 215 procedures[J]. Eur Urol, 2015, 67(6): 1152-1159. DOI: 10.1016/j.eururo.2014.12.021.
[6]	中华医学会男科学分会良性前列腺增生诊疗及健康管理指南编写组. 良性前列腺增生诊疗及健康管理指南[J]. 中华男科学杂志, 2022, 28(4): 356-365. DOI: 10.13263/j.cnki.nja.2022.04.012.
[7]	Taylor K, Filgate R, Guo DY, et al. A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs[J]. BJU Int, 2011, 108(Suppl 2): 45-50. DOI: 10.1111/j.1464-410X.2011.10686.x.
[8]	刘巍, 魏世平, 李晓山. 绿激光前列腺汽化术治疗围术期口服抗凝药患者疗效与安全性的Meta分析[J]. 微创泌尿外科杂志, 2021, 10(3): 195-201. DOI: 10.19558/j.cnki.10-1020/r.2021.03.010.
[9]	陈金虎, 张贤生, 张翼飞, 等. 绿激光前列腺汽化术在口服抗凝药物前列腺增生患者中的应用[J]. 临床泌尿外科杂志, 2019, 34(10): 804-808. DOI: 10.13201/j.issn.1001-1420.2019.10.011.
[10]	孟祥锋. 绿激光前列腺汽化术在口服抗凝药物前列腺增生患者中的应用[J]. 世界复合医学, 2021, 7(4): 4-7. DOI: 10.11966/j.issn.2095-994x.2021.07.04.02.
[11]	赵豫波, 刘萃龙, 于春杰, 等. 抗凝条件下经尿道前列腺绿激光汽化术55例[J]. 中国临床医师, 2013, 41(4): 45-47.
[12]	Campobasso D, Marchioni M, De Nunzio C, et al. Predictors of re-intervention after greenlight laser photoselective vaporization of the prostate: multicenter long/mid-term follow-up experience[J]. Mini Invasive Surg, 2021, 5: 45. DOI: 10.20517/2574-1225.2021.92.
[13]	Meskawi M, Hueber PA, Valdivieso R, et al. Complications and functional outcomes of high-risk patient with cardiovascular disease on antithrombotic medication treated with the 532-nm-laser photo-vaporization Greenlight XPS-180 W for benign prostate hyperplasia[J]. World J Urol, 2019, 37(8): 1671-1678. DOI: 10.1007/s00345-018-2560-8.
[14]	Huet R, Mathieu R, Rohou T, et al. MRI assessment of tissue effects after 180-W XPS greenlight laser vaporization of the prostate[J]. Lasers Surg Med, 2017, 49(6): 577-581. DOI: 10.1002/lsm.22629.
[15]	祝广记, 王佳悦. 经尿道直出绿激光选择前列腺汽化术治疗前列腺增生症[J]. 医药论坛杂志, 2020, 41(8): 68-70.

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Photoselective vaporesection of the prostate treatment of high-risk elderly patients with prostatic hyperplasia on perioperative maintenance of oral anticoagulants: a clinical observation

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Photoselective vaporesection of the prostate treatment of high-risk elderly patients with prostatic hyperplasia on perioperative maintenance of oral anticoagulants: a clinical observation