保留12点纵行尿道黏膜的前列腺钬激光剜除术治疗中小体积BPH的疗效分析  

The efficacy of HoLEP with preservation of longitudinal urethral mucosa at 12 o’clock for benign prostatic hyperplasia with small-medium gland

作　　者：黄建文[1] 罗志强 曹乃龙[1] 胡晓勇[1] 张炯[1] 郭辉[1] 宋鲁杰[1] 傅强[1] Huang Jianwen;Luo Zhiqiang;Cao Nailong;Hu Xiaoyong;Zhang Jiong;Guo Hui;Song Lujie;Fu Qiang(Department of Urology,Shanghai Jiaotong University Affiliated Sixth People’s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海200233

出　　处：《中华泌尿外科杂志》2022年第4期261-265,共5页Chinese Journal of Urology

基　　金：徐汇区重要疾病联合攻关项目(XHLHGG202109)。

摘　　要：目的探讨保留12点纵行尿道黏膜的经尿道前列腺钬激光剜除术(HoLEP)治疗中小体积良性前列腺增生(BPH)的效果。方法回顾性分析2018年10月至2021年4月在上海交通大学附属第六人民医院收治的256例中小体积(30~60 ml)BPH患者的病例资料。早期(2018年10月至2020年6月)186例为常规组,接受不保留12点纵行尿道黏膜的HoLEP;后期(2020年7月至2021年4月)70例为改良组,接受保留12点纵行尿道黏膜的HoLEP。常规组和改良组的年龄[(70.5±4.4)岁与(68.5±3.2)岁]、最大尿流率(Q_(max))[(7.5±2.8)ml/s与(7.5±2.1)ml/s]、国际前列腺症状评分(IPSS)[(20.3±4.6)分与(21.4±3.7)分]、生活质量(QOL)评分[(4.5±1.0)分与(4.2±1.4)分]、残余尿量[(126.9±29.4)ml与(132.2±32.3)ml]、前列腺特异性抗原(PSA)[(1.5±1.3)ng/ml与(1.8±1.1)ng/ml]和前列腺体积[(48.1±11.1)ml与(48.0±12.7)ml]比较差异无统计学意义(P>0.05)。两组均采用"三叶法"剜除前列腺。改良组是在常规组的基础上于12点位置保留1条自膀胱颈至前列腺尖部的纵行尿道黏膜,技术改良如下:①于增生腺体与外科包膜间隙内剜除5点至1点的左侧叶及尖部;②对称于7点至11点剜除右侧叶及尖部;③于1点和11点处分别纵向切开膀胱颈至尖部的尿道黏膜,保留12点(1点至11点间)的纵行黏膜。比较两组的手术效果和术后并发症。结果常规组和改良组在手术时间[(36.5±10.4)min与(40.7±9.7)min]、剜除腺体重量[(35.5±12.2)g与(31.6±10.4)g]、术后血红蛋白下降值[(6.1±2.2)g/L与(5.6±2.5)g/L]、术后住院时间[(1.2±0.2)d与(1.5±0.4)d]和留置尿管时间[(2.3±1.3)d与(2.0±1.0)d]方面差异无统计学意义(P>0.05)。252例获得随访,常规组183例,改良组69例,平均随访时间8.4个月。常规组和改良组术后IPSS分别为(5.4±2.3)分和(5.9±1.2)分,QOL评分分别为(1.5±0.3)分和(2.0±1.0)分,Q_(max)分别为(24.3±9.2)ml/s和(22.5±11.3)ml/s,残余尿量分别为(8.3±4.5)ml和(7.7±2.9)mObjective To explore the treatment experience of holmium laser enucleation of prostate(HoLEP)with preservation of longitudinal urethral mucosa at 12 o’clock for benign prostatic hyperplasia(BPH)with small-medium gland.Method From October 2018 to April 2021,256 patients diagnosed BPH with small-medium gland(prostate volume 30-60 ml)were retrospectively analyzed,including general information,way of operation,intraoperative parameters and follow-up data.From October 2018 to June 2020,186 BPH patients underwent conventional HoLEP,which did not retain longitudinal urethral mucosa at 12 o’clock as a conventional operation group.From July 2020 to April 2021,70 BPH patients underwent modified HoLEP,which retained longitudinal urethral mucosa at 12 o’clock as a modified operation group.There was no significant difference between the two groups(P>0.05)in term of the age[(70.5±4.4)years old vs.(68.5±3.2)years old],Q_(max)[(7.5±2.8)ml/s vs.(7.5±2.1)ml/s],IPSS[(20.3±4.6)vs.(21.4±3.7)],QOL[(4.5±1.0)vs.(4.2±1.4)],postvoid residual volume[(126.9±29.36)ml vs.(132.2±32.3)ml],PSA[(1.5±1.3)ng/ml vs.(1.8±1.1)ng/ml]and prostate volume[(48.1±11.1)ml vs.(48.0±12.7)ml].Both groups were treated with"trefoil"enucleation of prostate.The modified group was improved compared with the conventional group by retaining a 12 o’clock longitudinal urethra mucosa from the bladder neck to the apex of the prostate.The technical improvements were as follows:①the left lobe of prostate was removed from at 5 o’clock at the verumontanum to 1 o’clock at the prostate apex along the gap between the hyperplasia gland and the surgical envelope;②the right lobe was removed from 7 o’clock at the verumontanum to 11 o’clock at the apex;③the urethra mucous membrane was cut vertically from 1 and 11 o’clock at the bladder neck to 1 and 11 o’clock at the apex respectively,and retaining the longitudinal mucous membrane between 11 and 1 o’clock(including 12 o’clock).Efficacy and postoperative complications of the two groups were

关 键 词：前列腺增生 前列腺剜除术 钬激光 尿道黏膜 

分 类 号：R699.8[医药卫生—泌尿科学]