脉冲波铥光纤激光剜除术在前列腺增生治疗中的应用  

Application of pulsed Thulium fiber laser enucleation in treatment of benign prostatic hyperplasia

作　　者：兰孝达 车新艳 韩佳凝 杨昆霖 左超 张骞[1] 张凯[1] 孟一森[1] Lan Xiaoda;Che Xinyan;Han Jianing;Yang Kunlin;Zuo Chao;Zhang Qian;Zhang Kai;Meng Yisen(Department of Urology,Peking University First Hospital,Beijing 100034,China;Department of Urology Beijing Miyun District Hospital,Beijing 101500,China)

机构地区：[1]北京大学第一医院泌尿外科,北京10003 [2]北京市密云区医院泌尿外科,北京101500

出　　处：《中华泌尿外科杂志》2024年第5期372-378,共7页Chinese Journal of Urology

基　　金：国家重点研发计划重点专项资助(2022YFC3602902);中央高水平医院临床科研业务费资助(2023IR43,2023CX01)。

摘　　要：目的探讨脉冲波铥光纤激光剜除术治疗前列腺增生的安全性及有效性。方法回顾性分析2022年11月至2023年11月北京大学第一医院收治的238例行钰光纤激光前列腺剜除术治疗前列腺增生患者的临床资料。根据不同手术类型分组,接受传统连续波光纤激光前列腺剜除术患者199例(连续波光纤激光组),接受脉冲波铥光纤激光前列腺剜除术患者39例(脉冲波钰光纤激光组)。采用倾向性评分法匹配两组术前基线数据。记录匹配后两组的手术时间、切除组织质量、术后血红蛋白下降值、术后住院时间及术后尿管留置时间。记录并比较两组间围手术期资料和术后短期并发症。比较两组术后1个月的最大尿流率(Q_(max))、国际前列腺症状评分(IPSS)、国际勃起功能指数(IIEF-5)评分、生活质量评分(QOL)、国际尿失禁咨询委员会尿失禁问卷表简表(ICIQ-SF)评分差异,比较手术前后患者的Q_(max)、IPSS、QOL、IEF-5评分变化情况。结果匹配后共纳人60例患者,脉冲波铥光纤激光组和连续波光纤激光组各30例。两组年龄[(68.73±6.91)岁与(71.07±7.34)岁)、美国麻醉医师协会(ASA)评分(1~2/3~4分:23/7例与23/7例)、合并症数量(0~1/>1个:15/15例与15/15例)、前列腺体积[68.3(50.0,105.3)ml与63.3(45.7,106.0)ml],以及术前IPSS[24(21,29)分与23(14,26)分]、IIEF-5评分[5(0,15)分与5(013)分]、QOL[5(4,6)分与5(5,6)分]的差异均无统计学意义(P>0.05)。匹配后脉冲波铥光纤激光组的单位时间组织切除质量高于连续波光纤激光组0.82(0.71,1.18)g/min与0.72(0.46,0.95)g/min],而两组间手术时间[47(37,79)min与65(33,87)min、切除组织质量[45(31,75)g与33(22,65)g]、术后血红蛋白下降值[17(10,23)g/L与12(719)g/L]、术后住院时间[4(3,5)d与4(3,5)d]、术后尿管留置时间[3(3,5)d与3(3,6)d的差异均无统计学意义(P>0.05)。两组围手术期并发症发生率差异无统计学意义[均为10%(3/30),P=1.000],均未出Objective To investigate the safety and efficacy of pulsed Thulium fiber laser enucleation(ThuFLEP)in the treatment of benign prostatic hyperplasia(BPH).Methods Clinical data of 238 BPH patients who underwent ThuFLEP from November 2022 to November 2023 at Peking University First Hospital were retrospectively analyzed.Patients were divided into two groups based on different surgical techniques:199 patients underwent traditional continuous-wave Thulium fiber laser prostatectomy(C-ThuFLEP group),and 39 patients underwent Thulium fiber laser enucleation with pulse modulation(P-ThuFLEP group).Propensity score matching was used to balance baseline characteristics between the two groups.Operative time,resected tissue weight,pre-and postoperative hemoglobin decrease,postoperative hospital stay,and postoperative catheterization time were recorded and compared between the matched groups.Intraoperative and short-term postoperative complications were also recorded and compared between the two groups.Follow-up assessments at 1 month postoperatively were conducted to compare the maximum urinary flow rate(Q_(max)),international prostate symptom score(IPSS),international index of erectile function(IIEF-5)score,quality of life(QOL)score,and International Consultation on Incontinence Questionnaire Short Form(ICIQ-SF)score between the two groups,as wellas changes in Qmx and IPSS,IIEF-5,and QOL before and after surgery.Results After matching,a total of 60 patients were included,with 30 patients in each group.There were no statistically significant differences between the two groups in terms of age[(68.73±6.91)years vs.(71.07±7.34)years],American Society of Anesthesiologists(ASA)score(1-2/3-4:23/7 vs.23/7),comorbidity count(0-1/>1:15/15 vs.15/15),prostate volume[68.3(50.0,105.3)ml vs.63.3(45.7,106.0)ml],preoperative IPSS score[24(21,29)vs.23(14,26)],IEF-5 score[5(0,15)vs.5(0,13)],and QOL score[5(4,6)vs.5(5,6)](all P>0.05).The tissue removal rate in the P-ThuFLEP group was higher than that in the C-ThuFLEP group[0.82(0.71,1.18)g/min

关 键 词：前列腺增生 腔内解剖性前列腺剜除术 脉冲式铥光纤激光 疗效 

分 类 号：R699.8[医药卫生—泌尿科学]