绿激光前列腺剜除术对伴有逼尿肌收缩力低下的前列腺增生患者的疗效分析  

Clinical efficacy analysis of GreenLEP for BPH patients with detrusor underactivity

作　　者：全晶 薛文彬 黄新冕 徐智慧[1] 黄邦高 Quan Jing;Xue Wenbin;Huang Xinmian;Xu Zhihui;Huang Banggao(Urology&Nephrology Center,Department of Urology,Zhejiang Provincial People's Hospital,Affiliated People's Hospital,Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院、杭州医学院附属人民医院泌尿外科,杭州310014

出　　处：《中华泌尿外科杂志》2024年第1期18-23,共6页Chinese Journal of Urology

摘　　要：目的技探讨经尿道绿激光前列腺剜除术(GreenLEP)治疗良性前列腺增生(BPH)伴逼尿肌收缩力低下(DU)的效果。方法去回顾性分析2019年6月至2020年6月浙江省人民医院行GreenLEP治疗的157例BPH患者的临床资料。年龄(73.2±7.9)岁,病程4(2,8)年。所有患者术前均完善尿流动力学检查及前列腺B超(或增强MRI)检查。术前前列腺体积为42.1(34.2,59.4)ml,国际前列腺症状评分(IPSS)为(27.9±3.4)分,生活质量评分(QOL)为(5.1±0.8)分,术前残余尿量(PVR)为40.0(20.0,80.0)ml,术前最大尿流率(Q_(max))为4.0(2.0,7.0)ml/s。以膀胱收缩力指数(BCI)<100作为DU的诊断标准,将BPH患者分成DU组和非DU组。DU组76例,非DU组81例。术后3个月对上述患者进行随访,比较术前术后主观指标(IPSS、QOL)和客观参数(PVR、Q_(max))的变化。本研究中,将术后3个月复查PVR<20ml且Q_(max)>10ml/s定义为治疗成功,否则为治疗失败。根据治疗结局绘制受试者工作特征(ROC)曲线,寻找BCI预测治疗效果的的最佳截断值,根据BCI最佳截断值将DU患者分为轻度DU组和重度DU组。分析非DU组、轻度DU组、重度DU组术前主观指标(IPSS、QOL)和客观参数(PVR、Q_(max))的差异,以及术后3个月上述指标变化值(术后值与术前值的差)的差异。结果157例手术均顺利完成,住院时间6(5,8)d。术后随访3个月,非DU组治疗成功78例,治疗失败3例;DU组治疗成功64例,治疗失败12例。根据ROC曲线,BCI取最佳截断值为57.5,故轻度DU组(57.5≤BCI<100)56例,重度DU组(BCI<57.5)20例。术前3组患者年龄、病程以及前列腺体积差异均无统计学意义(P>0.05)。术前非DU组、轻度DU组、重度DU组的IPSS分别为(26.8±3.4)、(28.6±3.0)、(30.6±2.4)分,QOL分别为(4.9±0.9)、(5.2±0.7)、(5.7±0.5)分PVR分别为50.0(20.0,90.0)、20.0(10.0,50.0)、60.0(27.5,165.0)ml,Q_(max)分别为4.0(2.0,7.0)5.0(4.0,6.0)、0(0,2.3)ml/s。非DU组术前IPSS和QOL均明显低于轻度DU组和重度DU组(P<0.05)。Objective To investigate the effect of transurethral green laser prostate enucleation(GreenLEP)in the treatment of benign prostate hyperplasia(BPH)with detrusor underactivity(DU).Methods The clinical data of 157 BPH patients treated with GreenLEP at Zhejiang Provincial People's Hospital from June 2019 to June 2020 were retrospectively analysed.The average age of the patients was(73.2±7.9)years old,with disease duration of 4(2,8)years.Prior to surgery,all patients underwent comprehensive urodynamic studies and prostate ultrasonography(or enhanced MRI).Preoperative prostate volume was 42.1(34.2,59.4)ml,international prostate symptom score(IPSS)was(27.9±3.4),quality of life(QOL)score was(5.1±0.8),preoperative residual urine volume(PVR)was 40.0(20.0,80.0)ml,and preoperative maximum urinary flow rate(Q_(max))was 4.0(2.0,7.0)ml/s.Patients were stratified into DU and non-DU groups using a bladder contractility index(BCI)threshold of less than 100 to diagnose DU.The cohort comprised 76 individuals in the DU group and 81 in the non-DU group.At the three-month postoperative juncture,a follow-up assessment was conducted on the patients,focusing on the evolution of subjective metrics(IPSS,QOL)and objective parameters(PVR,Q_(max)).This study defined successful treatment outcomes at the 3-month mark as achieving PVR<20 ml and Q_(max)>10 ml/s.Cases not meeting these criteria were categorized as treatment failure.Based on treatment outcomes,receiver operator characteristic(ROC)curve were plotted to identify the optimal cutoff value of BCI for predicting treatment efficacy.Subsequently,DU patients were classified into mild and severe DU groups based on this optimal BCI threshold.The differences of subjective indicators(IPSS,QOL)and objective parameters(PVR,Q_(max))preoperatively among non-DU,mild DU,and severe DU groups,as well as changes in these indices three months postoperatively were analyzed.Results All 157 surgeries were successfully completed,with a median hospital stay of 6(5,8)days.At the 3-month postoperative follow

关 键 词：前列腺增生 逼尿肌收缩力低下 激光手术 绿激光 疗效 

分 类 号：R699[医药卫生—泌尿科学]