HoLEP对合并膀胱逼尿肌无力BPH患者尿潴留及尿动力学参数的影响  

The impact of transurethral holmium laser enucleation of prostate on urinary retention and urodynamic parameters in patients with benign prostatic hyperplasia and bladder detrusor muscle weakness

作　　者：陈亚梅 郑慧杰 谭公祥 付慧英 余春艳 施虹 余明主 CHEN Yamei;ZHENG Huijie;TAN Gongxiang;FU Huiying;YU Chunyan;SHI Hong;YU Mingzhu(Department of Urology,the 908th Hospital of Chinese People′s Liberation Army Joint Logistic Support Force,Nanchang 330002,Jiangxi,China;Department of Oncology,the 908th Hospital of Chinese People′s Liberation Army Joint Logistic Support Force,Nanchang 330002,Jiangxi,China;Department of Outpatient,the 908th Hospital of Chinese People′s Liberation Army Joint Logistic Support Force,Nanchang 330002,Jiangxi,China)

机构地区：[1]联勤保障部队第908医院泌尿外科,南昌330002 [2]联勤保障部队第908医院肿瘤科,南昌330002 [3]联勤保障部队第908医院门诊部,南昌330002

出　　处：《中国性科学》2025年第2期24-29,共6页Chinese Journal of Human Sexuality

基　　金：江西省卫生健康委科技计划项目(20210841)。

摘　　要：目的探讨经尿道钬激光前列腺剜除术(HoLEP)对合并膀胱逼尿肌无力良性前列腺增生(BPH)患者尿潴留及尿动力学参数的影响。方法选取2021年2月至2023年10月联勤保障部队第908医院收治的96例合并膀胱逼尿肌无力BPH患者作为研究对象,根据不同手术方案分为观察组(n=49)和对照组(n=47)。对照组采用经尿道前列腺切除术(TURP)治疗,观察组采用HoLEP治疗。比较两组手术相关指标、手术前后血清指标、尿动力学参数、性功能及前列腺症状、逼尿肌功能改善率、尿潴留发生率。结果观察组术中出血量低于对照组,导尿管留置、膀胱冲洗及住院时间均短于对照组,手术时间长于对照组(P<0.05)。术后3、7 d,两组血清白介素-8(IL-8)水平较术前1 d先升高后降低,两组血清血管内皮生长因子(VEGF)、环氧合酶-2(COX-2)水平较术前1 d均降低,且观察组IL-8、VEGF、COX-2水平均低于对照组(P<0.05)。术后1、3个月,两组残余尿量(RUV)较术前1 d降低,两组最大尿流率(Qmax)、充盈期膀胱内压力较术前1 d均升高,且观察组RUV低于对照组,Qmax、充盈期膀胱内压力高于对照组(P<0.05)。术后3个月,两组逼尿肌功能改善率比较,差异无统计学意义(P>0.05)。术后1、3个月,两组国际勃起功能指数-5(IIEF-5)评分及国际前列腺症状评分(IPSS)较术前1 d均降低,且观察组IIEF-5评分高于对照组,IPSS低于对照组(P<0.05)。术后3个月,两组尿潴留发生率比较,差异无统计学意义(P>0.05)。结论HoLEP治疗合并膀胱逼尿肌无力BPH患者可有效切除增生腺体,减轻机体损伤,抑制炎症所致病理状态造成的COX-2、VEGF表达上调,改善排尿功能,降低手术对性功能及前列腺症状的影响,在术后早期康复方面具有积极作用。Objective To explore the impact of transurethral holmium laser enucleation of prostate(HoLEP)on urinary retention and urodynamic parameters in patients with benign prostatic hyperplasia(BPH)and bladder detrusor muscle weakness.Methods A total of 96 patients with BPH and bladder detrusor muscle weakness who were admitted to The 908th Hospital of Chinese People′s Liberation Army Joint Logistic Support Force from February 2021 to October 2023 were selected as the research subjects.According to different surgical plans,they were divided into an observation group(n=49)and a control group(n=47).The control group was treated with transurethral resection of prostate(TURP),while the observation group was treated with HoLEP.Surgery-related indicators were compared between the two groups,as well as serum indicators,urodynamic parameters,sexual function and prostate symptoms,improvement rate of detrusor function,and incidence of urinary retention before and after operation.Results The amount of intraoperative bleeding in the observation group was lower than that in the control group,and the duration of catheterization,bladder irrigation,and hospital stay were shorter than those in the control group.The operation time was longer than that in the control group(P<0.05).On postoperative days 3 and 7,the levels of serum interleukin-8(IL-8)in both groups increased first and then decreased compared with the level on the day before surgery.The levels of serum vascular endothelial growth factor(VEGF)and cyclooxygenase-2(COX-2)in both groups decreased compared with the level on the day before surgery,and the levels of IL-8,VEGF,and COX-2 in the observation group were lower than those in the control group(P<0.05).At 1 and 3 months after surgery,the residual urine volume(RUV)in both groups decreased compared with that on the day before surgery,while the maximum flow rate(Qmax)and intravesical pressure during filling phase increased compared with that on the day before surgery.The RUV in the observation group was lower than that in the

关 键 词：良性前列腺增生 膀胱逼尿肌无力 钬激光 尿潴留 尿动力学 

分 类 号：R697[医药卫生—泌尿科学]