经尿道选择性绿激光前列腺汽化术与经尿道等离子前列腺电切术治疗不同体积前列腺增生的结局指标比较  

Transurethral greenlight photoselective vaporization of the prostate versus transurethral plasma kinetic resection of the prostate for the treatment of prostatic hyperplasia patients with different volumes

作　　者：伍宏亮[1] 汪盛[1] 陈志军[1] 王成勇[1] 杨帅[1] 孙文衍 韩兵 关翰 WU Hongliang;WANG Sheng;CHEN Zhijun;WANG Chengyong;YANG Shuai;SUN Wenyan;HAN Bing;GUAN Han(Department of Urology,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,安徽蚌埠233004

出　　处：《徐州医科大学学报》2024年第4期266-270,共5页Journal of Xuzhou Medical University

基　　金：安徽省自然科学基金青年项目(2008085QH358);蚌埠医学院第一附属医院优秀青年科学基金项目(2019byyfyyq09);蚌埠医学院512人才培育计划(by51202306);安徽省教育厅自然科学重点项目(2023AH051942)。

摘　　要：目的比较经尿道选择性绿激光前列腺汽化术(PVP)与经尿道等离子前列腺电切术(TUPKP)治疗不同体积前列腺增生患者的临床疗效。方法选择2019年1月—2022年1月于蚌埠医学院第一附属医院泌尿外科确诊的良性前列腺增生患者233例,根据术式不同分为PVP组(127例)和TUPKP组(106例)。根据前列腺彩超或MRI资料估算各组患者的前列腺体积,将患者再分为A组(<30 mL)、B组(30~80 mL)、C组(>80 mL)进行对比研究。结果A组和B组PVP术后血红蛋白下降值小于TUPKP术后,差异有统计学意义(P<0.01);而C组PVP术后血红蛋白下降值与TUPKP术后比较,差异无统计学意义(P>0.05)。A组和B组患者PVP手术时间均明显短于TUPKP手术时间(P<0.01),但C组患者PVP手术时间与TUPKP手术时间比较,差异无统计学意义(P>0.05)。A、B、C组患者PVP术后膀胱冲洗时间、留置导尿时间、平均住院时间明显短于TUPKP术后相应指标,差异有统计学意义(P<0.01)。并发症方面,PVP组电切综合征发生率低于TUPKP组(P<0.05);2组闭孔神经反射、尿失禁、尿道狭窄、膀胱颈挛缩的发生率比较,差异无统计学意义(P>0.05)。结论PVP作为一种新兴的治疗前列腺增生的手术方式,相较于传统的TUPKP,在手术时间、出血量、并发症方面均具有显著优势,特别是对于小体积前列腺增生患者。Objective To compare the clinical effectiveness of transurethral greenlight photoselective vaporization of the prostate(PVP)and transurethral plasma kinetic resection of the prostate(TUPKP)for the treatment of prostatic hyperplasia patients with different volumes.Methods A total of 233 patients who were diagnosed with benign prostatic hyperplasia in Department of Urology,the First Affiliated Hospital of Bengbu Medical College from January 2019 to January 2022 were selected.According to the corresponding operation type,they were divided into two groups:a PVP group(n=127)and a TUPKP group(n=106).The prostate volume of patients in each group was estimated based on prostate ultrasound or MRI data,and the patients were subdivided into group A(<30 mL),group B(30-80 mL),and group C(>80 mL)for comparative study.Results Groups A and B showed remarkably less hemoglobin drop values after PVP than those after TUPKP(P<0.01),whereas the hemoglobin drop value after PVP in Group C were not statistically different when compared with that after TUPKP(P>0.05).Groups A and B presented remarkably shorter surgical duration of PVP than TUPKP(P<0.01),whereas the surgical duration of PVP in Group C was not statistically different compared with that after TUPKP(P>0.05).Furthermore,after PVP,patients in groups A,B and C showed remarkable decreases in bladder irrigation time,indwelling catheterization time,and the length of hospitalization stay,compared with those after TUPKP(P<0.01).In terms of complications,the incidence of electroresection syndrome in the PVP group was lower than that in the TUPKP group(P<0.05).There was no statistical difference in the incidence of obturator nerve reflex,urinary incontinence,urethral stricture,and bladder neck contracture between the two groups(P>0.05).Conclusions Compared with traditional TUPKP,PVP is an emerging surgical approach for the treatment of prostatic hyperplasia,with significant advantages in operation duration,bleeding,and complications,especially for patients with small-sized prostate.

关 键 词：前列腺增生 经尿道选择性绿激光前列腺汽化术 经尿道等离子前列腺电切术 前列腺体积 血红蛋白 并发症 

分 类 号：R697[医药卫生—泌尿科学]