三种钬激光前列腺剜除术后尿失禁的比较  

Comparison of three Holmium laser enucleation of the prostate with postoperative urinary incontinence

作　　者：孙鹏[1] 徐旻 吴海啸[1] 黄汀 张恒 朱李 Sun Peng;Xu Min;Wu Haixiao;Huang Ting;Zhang Heng;Zhu Li(Department of Urology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院泌尿外科,金华321000

出　　处：《中华泌尿外科杂志》2024年第11期831-836,共6页Chinese Journal of Urology

摘　　要：目的探讨钬激光前列腺剜除术(HoLEP)保留不同结构治疗良性前列腺增生(BPH)的疗效及对术后尿失禁的影响。方法回顾性分析2020年6月至2023年6月于浙江大学医学院附属金华医院行钬激光前列腺剜除术的242例BPH患者的临床资料,其中89例行保留前列腺前叶或者部分前叶的HoLEP(A组),81例行保留前列腺尖部尿道黏膜的HoLEP(B组),72例行传统HoLEP(C组)。A、B、C组患者年龄[(73.72±6.35)岁与(72.58±6.14)岁与(73.18±6.73)岁]、前列腺体积[(82.31±43.58)ml与(81.54±42.83)ml与(82.12±44.27)ml]、糖尿病比例[11例(12.4%)与9例(11.1%)与7例(9.7%)]、膀胱结石比例[9例(10.1%)与6例(7.4%)与6例(8.3%)]、尿潴留比例[20例(22.5%)与17例(21.0%)与14例(19.4%)]、国际前列腺症状评分(IPSS)[(22.47±3.56)分与(21.83±4.18)分与(21.54±3.37)分]、生活质量评分(Q0L)[(4.87±0.92)分与(4.65±0.86)分与(4.74±0.73)分]、最大尿流率(Q_(max))[(8.32±3.09)ml/s与(8.41±2.75)ml/s与(7.96±2.82)ml/s]差异均无统计学意义(P>0.05)。比较三组围手术期相关指标,以及术后1周、1个月3个月的IPSS、QOL、Q_(max)、尿失禁发生率等。结果三组手术均顺利完成,无中转开放或改行其他术式。A、B、C三组手术刻除时间[(35.17±12.38)min与(34.19±10.26)min与(33.75±11.34)min]、前列腺剜除质量[(57.43±37.58)g与(59.72±38.35)g与(60.37±39.52)g]、留置尿管时间[(3.18±1.55)d与(3.62±1.78)d与(3.49±1.69)d]、包膜穿孔比例[1例(1.1%)与1例(1.2%)与2例(2.8%)]、术后感染比例[1例(1.1%)与1例(1.2%)与2例(2.8%)]差异均无统计学意义(P>0.05)。A组术后1周及术后1个月的IPSS[(9.41±2.21)、(8.34±1.67)分]、Q0L[(2.17±0.58)、(1.89±0.41)分]、Q_(max)[(20.53±5.18)、(22.41±6.17)ml/s]均较术前改善明显,差异均有统计学意义(P<0.05)。B组术后1周及术后1个月的IPSS[(10.19±2.47)、(8.73±1.81)分]、QOL[(2.63±0.62)、(2.14±0.57)分]、Q_(max)[(19.64±4.59)、(21.43±5.39)ml/s]均较术前改善明显,Objective To evaluate the clinical efficacy and advantage of urinary continence after holmium laser enucleation of the prostate(HoLEP)with reservation of different structures for benign prostatic hyperplasia(BPH).Methods The data of 242 patients with BPH who underwent HoLEP in Affliated Jinhua Hospital Zhejiang University School of Medicine from June 2020 to June 2023 were analyzed retrospectively.Of the 242 patients,89 received anterior lobe-sparing HoLEP(Group A),81 received HoLEP with partial urethral mucosa reservation(group B),and 72 received conventional HoLEP(group C).There were no significant differences among the three groups(P>0.05)in terms of the age[(73.72±6.35)years old vs.(72.58±6.14)years old vs.(73.18±6.73)years old],prostate volume[(82.31±43.58)ml vs.(81.54±42.83)ml vs.(82.12±44.27)ml],the proportion of diabetes mellitus[11 cases(12.4%)vs.9 cases(11.1%)vs.7 cases(9.7%)],the proportion of calculus of bladder[9 cases(10.1%)vs.6 cases(7.4%)vs.6 cases(8.3%)],the proportion of urinary retention[20 cases(22.5%)vs.17 cases(21.0%)vs.14 cases(19.4%)],international prostate symptom score(IPSS)[(22.47±3.56)vs.(21.83±4.18)vs.(21.54±3.37)],quality of life score(QOL)[(4.87±0.92)vs.(4.65±0.86)vs.(4.74±0.73)] and quantity of maximum flow rate(Q_(max))[(8.32±3.09)ml/s vs.(8.41±2.75)ml/s vs.(7.96±2.82)ml/s].The perioperative related indexes of the three groups were compared.IPSS,QOL,Q_(max),and the incidence of urinary incontinence at 1 week,1 month and 3 months after surgery were compared in the three groups.Results All procedures were performed successfully without conversion.Among groups A,B,and C,the differences of surgical enucleation time[(35.17±12.38)min vs.(34.19±10.26)min vs.(33.75±11.34)min],prostate enucleation mass[(57.43±37.58)g vs.(59.72±38.35)g vs.(60.37±39.52)g],retention of urinary catheter time[(3.18±1.55)d vs.(3.62±1.78)d vs.(3.49±1.69)d],the proportion of perforation of the peritoneum[1 case(1.1%)vs.1 case(1.2%)vs.2 cases(2.8%)],and the proportion of postoperative infect

关 键 词：前列腺增生 钬激光前列腺剜除术 尿失禁 疗效 

分 类 号：R699.8[医药卫生—泌尿科学]