经尿道钬激光前列腺剜除术中保留部分尿道黏膜对尿控及性功能的影响分析  

Preservation of partial urethral mucosa acting as a protective role of urinary continence and sexual func⁃tion in holmium laser enucleation of prostate

作　　者：闻竹 张超[2] 李清华[2] 张贤生[1] WEN Zhu;ZHANG Chao;LI Qinghua;ZHANG Xiansheng(Department of Urology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Urology,the First People′s Hospital of Hefei(Binhu Hospital of Hefei),Hefei 230000,China;不详)

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]合肥市第一人民医院(合肥市滨湖医院)泌尿外科,合肥230000

出　　处：《实用医学杂志》2023年第10期1237-1241,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金面上项目(编号:82071637)。

摘　　要：目的观察并探讨经尿道钬激光前列腺剜除术(HoLEP)中保留部分尿道黏膜对尿控及性功能的影响。方法回顾性分析医院2018年6月至2021年12月就诊的73例前列腺增生患者资料,其中39例以保留部分尿道黏膜的HoLEP术治疗(改良组);另34例以常规HoLEP术治疗(传统组)。比较两组患者术前与术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、尿流率检测(Qmax)、残余尿(PVR)、前列腺特异性抗原(PSA)等指标变化情况;并观察两组患者术后尿失禁及性功能改变情况(逆行射精发生率及IIEF⁃5评分)。结果围手术期内两组患者血红蛋白下降值、手术时间、留置尿管时间、切除腺体质量等指标差异无统计学意义(P>0.05)。所有患者术后随访12个月,两组间PSA、Qmax、IPSS、QOL及IIEF⁃5比较差异无统计学意义(P>0.05);在短暂性尿失禁、逆行射精发生率的比较中,改良组明显优于传统组(P<0.05)。结果改良HoLEP术式保留尿道黏膜不会增加手术风险,在达到同样疗效的情况下,可以有效降低尿失禁及逆行射精的发生率,提高患者术后生活质量。Objective To analyze the effect of preservation of partial urethral mucosa on urinary conti⁃nence and sexual function in holmium laser enucleation of the prostate(HoLEP).Methods From June 2018 to December 2021,the data of 73 patients with benign prostatic hyperplasia in our hospital were retrospectively analyzed.Among them,39 patients were treated with the modified HoLEP,and the others were treated with classic HoLEP.The two groups of patients were compared in terms of post⁃void residual volume(PVR),prostate specific antigen(PSA),peak urinary flow rate(Qmax),international prostate symptom score(IPSS),and quality of life(QOL).The changes in urinary incontinence and sexual function(incidence of retrograde ejaculation and interna⁃tional index of erectile function score)were observed in the two groups after operation.Results There was no significant difference in the amount of postoperative hemoglobin decline,the average operation time,indwelling catheterization time and weight of resected glands(P>0.05).After 12 months,there was no significant difference in PSA,Qmax,IPSS,QOL and IIEF⁃5 between the two groups(P>0.05).The incidence of transient urinary incontinence and retrograde ejaculation in the modified group was significantly better than that in the classic group(P<0.05).Conclusion The modified HoLEP with urethral mucosa preservation does not increase the risk of operation.With the same efficacy,it can effectively reduce the incidence of urinary incontinence and retrograde ejaculation,and improve the quality of life of patients after surgery.

关 键 词：良性前列腺增生 钬激光 剜除术 手术技巧 疗效 

分 类 号：R697.3[医药卫生—泌尿科学]