经尿道两种术式治疗良性前列腺增生的疗效比较  

Comparison of the clinical efficacies in treating benign prostatic hyperplasia by Holmium laser enucleation versus transurethral resection

作　　者：张振兴[1] 董昌斌[1] 姜书传[1] 韩杰[1] 黄后宝[1] 卓栋[1] 黄群联[1] 敖平[1] 

机构地区：[1]皖南医学院第一附属医院弋矶山医院泌尿外科,安徽芜湖241001

出　　处：《皖南医学院学报》2016年第6期551-554,共4页Journal of Wannan Medical College

摘　　要：目的：通过与经尿道前列腺电切术的比较，评估经尿道前列腺钬激光剜除术治疗良性前列腺增生的临床疗效。方法：收集皖南医学院弋矶山医院2015年2月～2016年4月具手术指征的102例前列腺增生患者资料，最终随访有效数据96例，所有患者均行经尿道前列腺钬激光剜除术（HoLEP）或经尿道前列腺电切术（TURP），两种术式为同一医师操作；评估指标包括术前资料：年龄、国际前列腺症状评分（ IPSS）、最大尿流率、前列腺体积、残余尿量、术前血红蛋白和血浆PSA；术中资料：手术时间，组织粉碎时间和膀胱黏膜损伤并发症；术后资料：术后第1天血红蛋白及血钠，术后导尿管引流时间及住院时间，术后1月最大尿流率及IPSS评分。结果：45例患者行HoLEP，51例行TURP，术前平均最大尿流率为8．5mL／s，IPSS评分分别为21分、22分，平均手术时间为88 min、67 min（P＜0．05），术后Hb下降值为9．8 g／L、13．2 g／L，P＜0．05），术后住院时间为4．2 d、6．5 d（P＜0．05），术后1月最大尿流率分别升至19．5 mL／s、18．5 mL／s（P＝0．378），IPSS评分均降至3分。结论：HoLEP 和TURP均为治疗良性前列腺增生的安全有效的方法，但HoLEP 失血量更低，住院时间更短，是未来手术治疗良性前列腺增生的发展趋势。Objective： To compared the clinical efficacies in treatment of benign prostatic hyperplasia （BPH）by Holmium laser enucleation of the prostate （HoLEP） versus transurethral resection of the prostate （TURP）.Methods：102 patients with BPH and surgical indications were initially selected from the First Affiliated Hospital of Wannan Medical College between February 2015 and April 2016.Ninety-six cases eligible to criteria by final follow-up were in-cluded in this study .All patients underwent either HoLEP or TURP by the same urologist .The data evaluated in this study consisted of preoperative infor-mation, including patient＇s age, International Prostate Symptom Score（IPSS）, maximum urinary flow rate（Qmax）, prostate size, residual urine volume, hemoglobin（ Hb） and serum PSA levels;intraoperative data, including operative time, time for crushing the prostatic tissues and complications associated with the bladder mucosa; and postoperative records, including levels of hemoglobin and serum sodium measured in the first postoperative day , time of postoperative maintenance of catheter drainage and hospital stay as well as Q max one month following operation and IPSS scores.Results：Forty-five patients underwent HoLEP, and 51 TURP.Preoperative Qmax was 8.5mL/s for both groups of patients, and IPSS scores were 21 points versus 22 points.Average operative time was 88 min vs.67 min（P〈0.05）.Hb was decreased from preoperative 9.8 g/L to postoperative 13.2 g/L（P〈0.05）.Postoperative hospital stay and Qmax one month after operation were 4.2 d vs.6.5d and 19.5 mL/s vs.18.5 mL/s, respectively, for the two groups （P=0.378）, and IPSS scoring was decreased to 3 points.Conclusion：HoLEP and TURP are both safe and effective approaches to BPH , yet HoLEP has lower blood loss and shorter hos-pital stay, suggesting that it will be the first option for benign prostate hyperplasia.

关 键 词：前列腺 钬激光 剜除术 前列腺增生 

分 类 号：R699[医药卫生—泌尿科学]