低功率钬激光前列腺剜除术治疗老年良性前列腺增生临床分析  

Clinical analysis of low-powered holmium laser enucleation of prostate for benign prostatic hyperplasia in elderly patients

作　　者：汤庆峰 黄晓科 刘承万 赖维奇[1] 李亮 Tang Qingfeng;Huang Xiaoke;Liu Chengwan;Lai Weiqi;Li Liang(Department of Urology,Chengdu Xindu District People's Hospital,Chengdu 610500,China)

机构地区：[1]四川省成都市新都区人民医院泌尿外科,610500

出　　处：《中华老年病研究电子杂志》2022年第3期37-41,共5页Chinese Journal of Geriatrics Research(Electronic Edition)

基　　金：白求恩公益基金项目(ZHYH201809004)。

摘　　要：目的探讨低功率钬激光前列腺剜除术(LP-HoLEP)治疗老年良性前列腺增生(BPH)的手术效果、安全性及学习曲线。方法选取2019年11月至2021年1月新都区人民医院具有300例以上经尿道前列腺切除术(trans-urethral resection of prostate,TURP)和150例以上LPHoLEP手术经验的同一术者开展的前60例老年BPH患者。按照手术先后顺序将患者分为A、B、C组,每组各20例。比较各组患者的手术效果和安全性,并绘制术者的学习曲线。计量资料的组间比较采用方差分析和非参数检验,计数资料的组间比较采用χ^(2)检验。结果3组患者手术时间、手术剜除时间、剜除效率的差异均有统计学意义(F=32.068、8.652、4.025,P<0.05或0.01),其中C组手术时间和手术剜除时间最短、剜除效率最高(P<0.05)。3组患者手术相关并发症发生率的差异无统计学意义(χ^(2)=2.682,P>0.05)。3组患者术后3个月随访情况的差异无统计学意义(P>0.05)。LP-HoLEP自主学习曲线约30例,在达到45例后术者水平逐渐趋于平稳。结论LP-HoLEP治疗老年BPH疗效肯定、安全可靠、并发症少,对于有内镜手术经验的泌尿科医生,自学掌握LP-HoLEP需要约30例手术实践。Objective To investigate the surgical efficiency,safety and learning curve of low-powered holmium laser enucleation of prostate(LP-HoLEP)for the treatment of benign prostatic hyperplasia(BPH)in elderly patients.Methods The data of 60 elderly patients with BPH who were performed by the same urologist with more than 300 trans-urethral resection of prostate and more than 150 LP-HOLEP surgeries in Xindu District People's Hospital of Chengdu from November 2019 to January 2021 were retrospectively analyzed.The patients were divided into group A,B and C according to the order of operation,with 20 cases in each group.The efficacy and safety were compared among the groups,and the learning curve of the operater was determined.One-way analysis of variance and non-parametric test were used to compare measurement data,χ^(2) test was used for comparison of count data.Results There were statistically significant differences in operation time,enucleation time and enucleation efficiency among the three groups(F=32.068,8.652,4.025,P<0.05 or P<0.01).Among the three groups,group C had the shortest operation time and enucleation time and the highest enucleation efficiency(P<0.05).There was no significant difference in the incidence of surgery related complications among the three groups(χ^(2)=2.682,P>0.05).There was no significant difference in the follow-up of 3 months after operation among the three groups (P > 0.05). According to the LP-HoLEP self-learning curve, the enucleation efficiency was significantly improved with 30 surgical practices, and after 45 surgical practices, the operation level of doctors became stable. Conclusion LP-HoLEP is safe and reliable in the treatment of BPH, with few complications, complete enucleation, and wide adaptability. For urologists with endoscopic surgery experience, self-taught LP-HoLEP requires 30 surgical practices.

关 键 词：钬激光 前列腺剜除术 良性前列腺增生 老年人 疗效 学习曲线 

分 类 号：R699.8[医药卫生—泌尿科学]