经尿道前列腺铥激光剜切术治疗大体积BPH的疗效分析  

Efficacy of Thulium laser enucleation-resection of prostate for benign prostatic hyperplasia with large gland

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

机构地区：[1]上海交通大学医学院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》2024年第2期103-107,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：目的探讨经尿道前列腺铥激光剜切术(ThuLERP)治疗大体积(>80 ml)良性前列腺增生(BPH)的疗效。方法回顾性分析2018年12月至2022年1月上海交通大学医学院附属第六人民医院收治的154例BPH患者的临床资料, 根据手术方式分为ThuLERP组和经尿道前列腺铥激光剜除术(ThuLEP)组, 每组均77例。ThuLERP组和ThuLEP组的年龄[(71.3±15.3)岁与(67.5±15.1)岁]、术前最大尿流率(Q_(max))[(9.5±3.5)ml/s与(8.9±2.4)ml/s]、国际前列腺症状评分(IPSS)[(20.5±3.6)分与(21.7±3.4)分]、生活质量(QOL)评分[(4.6±1.1)分与(4.4±1.5)分]、残余尿量[(124.7±24.3)ml与(130.2±22.4)ml]、前列腺特异性抗原(PSA)[(2.7±1.3)ng/ml与(2.9±1.5)ng/ml]和前列腺体积[(108.1±21.1)ml与(116.0±24.7)ml]比较差异均无统计学意义(P>0.05)。两组均采用"三叶法"进行手术。ThuLERP采用解剖性剜除结合汽化切割的方式进行手术, 在精阜两侧钝性推剥两侧腺体, 寻找外科包膜平面, 首先钝性剜除中叶, 然后分别钝性剜除左、右侧腺体至3点、9点处, 再汽化12点处腺体形成沟槽, 最后分别汽化切割3点至12点间、9点至12点间的左、右侧腺体。ThuLEP组采用解剖性剜除。比较两组的手术效果和术后并发症。结果 ThuLERP组和ThuLEP组的剜除时间[(51.0±11.3)min与(65.4±13.5)min]、手术时间[(62.5±20.4)min与(78.5±19.8)min]比较差异均有统计学意义(P<0.05);剜除腺体重量[(63.4±14.2)g与(71.5±21.5)g]、术后血红蛋白下降值[(9.1±3.7)g/L与(8.5±3.5) g/L]、术后住院时间[(1.3±0.2)d与(1.4±0.5)d]和留置尿管时间[(2.5±1.5)d与(2.8±1.9)d]比较差异均无统计学意义(P>0.05)。所有患者均获得随访, 术后随访6个月。ThuLERP组和ThuLEP组术后IPSS分别为(5.6±2.2)分和(6.7±1.4)分, QOL评分分别为(1.6±0.4)分和(2.1±0.8)分, Q_(max)分别为(27.6±10.2)ml/s和(29.5±14.7)ml/s, 残余尿量分别为(10.3±5.5)ml和(7.9±3.7)ml。与术前比较, 两组均明显改善, 差异有统�Objective To explore the treatment experience of Thulium laser enucleation-resection of prostate(ThuLERP)for benign prostatic hyperplasia(BPH)with large gland.Methods The clinical data of 154 BPH patients with large gland(prostate volume>80 ml)were analyzed retrospectively from December 2018 to January 2022.Seventy-seven patients underwent ThuLERP and 77 patients underwent ThuLERP and 77 patients received Thulium laser enucleation of prostate(ThuLEP).There were no significant differences between both groups(P>0.05)in term of the age[(71.3±15.3)years old vs.(67.5±15.1)years old],Q_(max)[(9.5±3.5)ml/s vs.(8.9±2.4)ml/s],IPSS[(20.5±3.6)vs.(21.7±3.4)],Q0L[(4.6±1.1)vs.(4.4±1.5)],postvoid residual volume[(124.7±24.3)ml vs.(130.2±22.4)ml],PSA[(2.7±1.3)ng/ml vs.(2.9±1.5)ng/ml] and prostate volume[(108.1±21.1)ml vs.(116.0±24.7)ml].Both groups were treated with a three-lobe technique.ThuLERP was performed using anatomical enucleation combined with vaporization cut technique.The glands were bluntly dissected to established the surgical capsule plane on both sides of the verumontanum.At first,the middle lobe was bluntly enucleated;Secondly,left and right lobe were bluntly enucleated to 3 oclock and 9 o'clock,respectively;Thirdly,the glands formed grooves at 12 o'clock after vaporization,which served as anatomical marker;At last,left and right lobe were resected using laser from 3 oclock to 12 oclock and 9 oclock to 12 oclock,respectively.ThuLEP was performed using anatomical enucleation technique.Efficacy and postoperative complications of the two groups were compared.Results The difference between ThuLERP group and ThuLEP group in enucleation time[(51±11.3)min vs.(65.4±13.5)min]and operation time[(62.5±20.4)min vs.(78.5±19.8)min]were statistically significant(P<0.05).However,the difference between both groups in glandular weight of enucleation[(63.4±14.2)g vs.(71.5±21.5)g],hemoglobin decrease[(9.1±3.7)g/L vs.(8.5±3.5)g/L],postoperative hospital stay[(1.3±0.2)d vs.(1.4±0.5)d]and catheter indwelling dur

关 键 词：良性前列腺增生 前列腺剜除术 前列腺切除术 铥光纤激光 疗效 

分 类 号：R699.8[医药卫生—泌尿科学]