日间手术模式下开展铥激光腔内解剖性前列腺剜除术的临床研究  

Clinical study of thulium laser endoluminal anatomical prostate enucleation in ambulatory surgery mode

作　　者：邹志辉 胡永涛 张礼刚[1,2,3] 陈佳 葛秦涛[1,2,3] 陆姚 张静 李芳芳[6] 宋真[1,2,3] 郝宗耀[1,2,3] 梁朝朝[1,2,3] Zou Zhihui;Hu Yongtao;Zhang Ligang;Cheng Jia;Ge Qintao;Lu Yao;Zhang Jing;Li Fang;Song Zhen;Hao Zongyao;Liang Chaozhao(Department of Urology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Anhui Province Key Laboratory of Genitourinary Diseases,Hefei 230022,China;Anhui Clinical Research Center of Urinary System Diseases,Hefei 230022,China;Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Day Operating Room,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Day Surgery Ward,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科,合肥230022 [2]泌尿生殖系统疾病安徽省重点实验室,合肥230022 [3]安徽省泌尿系统疾病临床医学研究中心,合肥230022 [4]安徽医科大学第一附属医院麻醉科,合肥230022 [5]安徽医科大学第一附属医院日间手术室,合肥230022 [6]安徽医科大学第一附属医院日间手术病房,合肥230022

出　　处：《微创泌尿外科杂志》2022年第2期100-105,共6页Journal of Minimally Invasive Urology

基　　金：国家临床重点专科建设项目基金(2011299);安徽省第六批卫生健康适宜技术推广项目(SYJS202110);安徽医科大学校科研基金(2020xkj189);安徽医科大学第一附属医院临床研究项目(PJ2018-13-23)。

摘　　要：目的:探讨经尿道铥激光前列腺剜除术(ThuLEP)日间手术模式治疗前列腺增生(BPH)的安全性及可行性。方法:分析安徽医科大学第一附属医院2021年10月至2022年3月,经过门诊筛查并接受ThuLEP日间手术的56例BPH患者的临床资料。患者入院当天即安排手术,手术由同一医生完成,遵循解剖性腔内前列腺剜除术标准,麻醉苏醒后即常规进食水;术后第1天停膀胱冲洗并拔除导尿管,并进行出院评估。记录患者的基线资料、围手术期结果、康复速度,住院费用,并报道术后1月的功能结果及手术并发症发生率。结果:患者平均年龄为61.6±5.2(52~75)岁、前列腺体积为52.6(37.7,66.0)mL。所有患者手术均获成功,平均手术时间36.6(24.0,40.0)min。术后平均血红蛋白上升0.8±0.3 g/dL。术后平均膀胱冲洗时间16.3±2.1 h、留置导尿22.1±3.7 h。所有患者均于术后第一天上午出院,平均术后住院时间16.7±2.5 h、总住院时间21.6±0.5 h,平均住院费用13130±320元。术后1个月平均国际前列腺症状评分4.5(3.0,6.3)vs.26.7(22.0,29.0)、生活质量评分1.5(1.0,2.0)vs.5.0(5.0,6.0)、最大尿流率21.2(16.2,29.0)mL/s vs.8.8(5.2,11.7)mL/s较术前均有明显改善(P均<0.01)。出院前5例需重新留置尿管,术后5例发生尿道狭窄、3例发生膀胱颈挛缩3例,无其它Clavien 2级及以上并发症发生。结论:本研究首次报道ThuLEP日间手术。初步结果显示,在病人合适及技术成熟的条件下,ThuLEP日间手术是一种治疗BPH安全、可行、经济、高效的模式,可以在有条件的医院推广。Objective:To evaluate the feasibility and safety of thulium laser transurethral enucleation of the prostate(ThuLEP)in the treatment of benign prostatic hyperplasia(BPH)in a day surgery mode.Methods:Between October 2021 and March 2022,a total of 56 BPH patients received outpatient screening and underwent day-surgery of ThuLEP in the First Affiliated Hospital of Anhui Medical University.Patients completed all preoperative examinations during the pre-hospitalization period,and the operation was arranged on the day of admission.All operations were performed by Dr.Zou.The operation followed the standard of anatomic prostatic enucleation,and the adenoma was completely removed(shown as video and illustrations).Drinking and eating started at the time of postoperative anesthesia revival.Bladder irrigation and urinary catheter were stopped on the first postoperative day and the subsequent discharge evaluation was conducted.The baseline data,perioperative results,rehabilitation,hospitalization expenses,functional results and complications at the first postoperative month were prospectively recorded.Results:Average age and prostate volume were 61.6±5.2(52-75)years and 52.6(37.7,66.0)mL,respectively.All procedures were successfully completed with a mean operation time of 36.6(24.0,40.0)min.All patients were allowed to drink and drink after recovery from anesthesia.A decrease in hemoglobin was 0.8±0.3 g/dL.Average postoperative irrigation was 16.3±2.1h,and indwelling catheterization time was 22.1±3.7 h.All patients were discharged in the morning on the first postoperative day.The average hospital stay was 16.7±2.5 h,the total hospital stay was 21.6±0.5 days and the total hospitalization cost was 13130±320 RMB.The 1-month follow-up results showed a substantial improvement in the International Prostate Symptom Score from 26.7(22.0,29.0)to 4.5(3.0,6.3),Quality of Life score from 5.0(5.0,6.0)to 1.5(1.0,2.0),andmaximum urinary flow rate from 8.8(5.2,11.7)mL/s to 21.2(16.2,29.0)mL/s(all P<0.001).Five patients received indwell

关 键 词：良性前列腺增生症 经尿道手术 铥激光前列腺剜除术 快速康复 日间手术 

分 类 号：R697.32[医药卫生—泌尿科学]