刀口变向钬激光前列腺剜除术肌层无损伤解剖性松解膀胱颈治疗小体积前列腺增生  

Effect of Anatomical Release of Bladder Neck of Turning Holmium Laser Enucleation of Prostate for Small Volume Benign Prostatic Hyperplasia

作　　者：龙蠡[1] 杨华伟[1] 唐汇龙[1] 蔡蔚[1] 谢晓[1] 谭谈[1] 谢海平[1] LONG Li;YANG Hua-wei;TANG Hui-long;CAI Wei;XIE Xiao;TAN Tan;XIE Hai-ping(Department of Urology, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan, China)

机构地区：[1]湖南中医药大学第一附属医院泌尿外科,长沙410007

出　　处：《中国现代手术学杂志》2022年第1期45-50,共6页Chinese Journal of Modern Operative Surgery

基　　金：湖南省卫健委科研项目(202104051076);湖南中医药大学校级课题(2020XJJJ047);湖南省残疾人康复科研项目(2021XK0210);湖南省中医药科研计划项目(2021080);湖南省普通高等学校教学改革研究项目(HNJG-2021-0602)。

摘　　要：目的比较经尿道刀口变向钬激光前列腺剜除术(turning holmium laser enucleation of prostate,THolEP)与经尿道前列腺电切术(transurethral resection of prostate,TURP)+膀胱颈切开术(transurethral incision of bladder neck,TUIBN)治疗小体积前列腺增生(benign prostatic hyperplasia,BPH)的疗效和安全性。方法选取2019年1月至2020年1月在我院手术治疗的小体积BPH患者65例,随机分为两组,分别行THolEP术(THolEP组,33例)和TURP+TUIBN术(TURP+TUIBN组,32例)。比较两组手术指标及术后1、3、6、12、18个月国际前列腺症状评分(international prostate symptom score,IPSS),生活质量(quality of life,QOL)评分,最大尿流率(Qmax),残余尿量(residual urine volume,RUV)及术后逆行射精发生率。结果两组手术均顺利完成,均未发生电切综合征。THolEP组术中切除组织量大于TURP+TUIBN组(P<0.05),而两组手术时间、术中出血量比较,差异无统计学意义(P>0.05)。THolEP组和TURP+TUIBN组术中发生前列腺包膜穿孔分别为1例和6例,术后1周发生压力性尿失禁分别为2例和8例,组间比较差异有统计学意义(P<0.05)。行盆底肌收缩训练3个月后两组均无尿失禁病例。术后2个月TURP+TUIBN组1例出现尿道狭窄,定期进行尿道扩张后缓解。两组患者均于术后1、3、6、12、18个月进行随访。两组术后各时点IPSS、QOL、Qmax及RUV均较术前明显改善(P<0.05);组间比较,THolEP组术后各时点上述指标均明显优于TURP+TUIBN组(P<0.05)。术后6、12、18个月随访逆行射精发生率,TURP+TUIBN组分别为31.3%、28.1%及28.1%,明显高于THolEP组的9.1%(P<0.05)。结论THolEP肌层无损伤解剖性松解膀胱颈治疗小体积BPH,疗效确切,症状缓解明显,并发症少,值得临床推广。Objective To compare the effect of turning holmium laser enucleation of prostate(THolEP)and transurethral resection of prostate(TURP)combined with transurethral incision of bladder neck(TUIBN)in the treatment of benign prostate hyperplasia(BPH)small volume.Methods A total of 65 BPH cases with small volume(<30 g)performed surgical treatment in our hospital from January 2019 to January 2020 were selected and divided randomly into two groups:33 cases were performed THolEP(as the THolEP group),and 32 cases were carried out TURP+TUIBN(as the TURP+TUIBN group).The surgical indicators,International Prostate Symptom Score(IPSS)and Quality of Life(QOL)scores,maximum urine flow rate(Qmax)and residual urine volume(RUV)of 1-,3-,6-,12-and 18 months after the surgery,and the incidence of retrograde ejaculation of 6-,12-and 18 months after the surgery were compared between the two groups.Results All surgical interventions were successful without transurethral electroresection syndrome(TURS).The weight of resected tissue of THolEP group was larger than that of TURP+TUIBN group(P<0.05).There was no statistic difference in operative time and intra-operative bleeding volume between the two groups(P>0.05).The intra-operative perforation of prostatic capsule was found in one case and 6 cases,and stress urinary incontinence(SUI)was in 2 cases and 8 cases one week after the surgery in the THolEP group and TURP+TUIBN group respectively,and there was statistical differences between the two groups(P<0.05).All the SUI cases recovered 3 months after pelvic floor muscle contraction training.One patient of TURP+TUIBN group was found urethral stricture and relieved after regular urethral dilatation 2 months after the operation.All 65 patients were followed up.IPSS,QOL,Qmax and RUV of both groups were significantly improved at each time point after the operation than those before the operation(P<0.05).The IPSS,QOL,Qmax and RUV of 1-,3-,6-,12-and 18 months after the operation were significantly better in the THolEP group than those in the TURP+T

关 键 词：刀口变向钬激光前列腺剜除术 前列腺增生 小体积 

分 类 号：R697.32[医药卫生—泌尿科学]