2微米激光剥橘式前列腺切除术对良性前列腺增生患者勃起功能的影响  

Influences of erectile functions in benign prostatic hyperplasia patients by two micro （thulium） laser resection of prostate-tangerine technique

作　　者：罗光恒[1] 孙兆林[1] 夏术阶[2] 

机构地区：[1]贵州省人民医院泌尿外科,贵阳550002 [2]上海交通大学泌尿外科研究所

出　　处：《中华医学杂志》2011年第32期2243-2246,共4页National Medical Journal of China

基　　金：中国博士后科学基金（20100470126）;贵州省科技厅基金（黔科合计省合2010[7003],（黔科合SY字[2011]0024）

摘　　要：目的评估2μm激光剥橘式前列腺切除术治疗良性前列腺增生对患者勃起功能的影响。方法良性前列腺增生患者50例接受2μm激光剥橘式前列腺切除术，术后6个月随访，分别对患者前列腺体积、国际前列腺症状评分（IPSS）、最大尿流率和国际勃起功能评分（IIEF-5）进行测定。患者按前列腺体积≤50ml或〉50ml，年龄≤65岁或〉65岁，IIEF-5≤20或〉21和IPSS评分≤27或〉27分各自分为2组。评价患者的年龄、前列腺体积和下尿路症状（LUTS）对2μm激光剥橘式前列腺切除术治疗良性前列腺增生患者勃起功能（ED）的影响。结果所有患者均一次成功完成手术，术后下尿路梗阻症状均得到明显缓解。患者术前／术后6个月的IPSS评分和最大尿流率分别为（25．4±3．6）／（9．5±3．1）和（6．5±1．21）／（13．4±2．7）ml／s，患者术前术后IPSS评分／最大尿流率比较差异均有统计学意义（均P〈0．01）。术前ED患者34例，术后32例，手术前后比较差异无统计学意义（x^2=0．673，P=0．603）。体积〉50ml组患者术后新增加ED患者9例（x^2=5．255，P=0．002），两组问差异有统计学意义；而IPSS评分〉27分组患者接术后ED患者减少11例（x^2=11．560，P=0．001），差异有统计学意义。年龄〉65较≤65岁组患者均容易合并ED（x^2=5．882，P=0．015），差异有统计学意义；然而手术对患者的年龄与ED发生差异无统计学意义（x^2=3．125，P=0．077）。结论2um激光剥橘式前列腺切除术可明显改善良性前列腺增生患者下尿路梗阻症状。年龄是良性前列腺增生合并ED的影响因素；前列腺的体积是2μm激光剥橘式切除术新增ED的独立因素，是导致ED的独立危险因素，2μm激光前列腺剥橘式术可减少重度LUTS患者ED的发生。Objective To observe the influences of erectile dysfunction （ED） by age, prostate size and lower urinary tract symptom （ LUTS ） undergoing two micro （ thulium ） laser resection of prostatetangerine technique （TmLRP-TT）. Methods A total of 50 BPH （benign prostatic hyperplasia） patients underwent TmLRP-TT with a 70 W laser power. The patient prostate volume, international prostatic symptomatic score （IPSS） , maximal flow rate and international index of erectile function （ IIEF-5 ） were assessed preoperatively. A retrospective assessment was made after surgery and at a 6-month follow-up. They were divided into 2 groups according to prostate volume ≤ 50 or 〉 50 ml, age ≤ 65 yrs or 〉 65 yrs, IIEF-5≤20 or 〉 21 and IPSS ≤27 or 〉 27 respectively. The postoperative influences of erection by age, prostate size and LUTS were observed. Results Significant differences existed between pre-operation and 6 months post-operation in terms of IPSS （ 25.35 ± 5.6 vs 9. 52 ± 3.1, P 〈 0. 01 ） and maximal flow rate （6. 51 ± 1.21 vs 13.4 ±2. 7 ml/s, P 〈0. 01 ）. There was no difference between pre-operation and 6 months post-operation （34 vs 32 cases, x^2 = 0. 673, P = 0. 603）. The patients with prostate volume 〉 50 ml group had 9 additional ED cases while those with IPSS 〉 27 group contained 11 fewer ED cases. There were significant differences between both groups （x^2 = 5. 255, P = 0. 002; x^2 = 11. 560, P = 0. 001 respectively）. BPH patients aged over 65 years old were more likely to suffer ED than those under 65 years old （x^2 = 5. 882, P =0. 015）. However, there was no significant difference in age in terms of suffering postoperative ED （x^2 = 3. 125, P = 0. 077）. Conclusion TmLRP-TT can significantly improve LUTS in BPH patients. The presence of large volume prostate is an independent risk factor for an increased number of ED patients after TmLRP-TT. LUTS is an independent risk factor for ED. And TmLRP-TT may improve the ED patients with severe LUTS.

关 键 词：前列腺切除术 前列腺增生 勃起功能障碍 

分 类 号：R699[医药卫生—泌尿科学]