主动保留尿控结构的HoLEP和TUPKEP疗效对比分析
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摘要
目的:探讨主动保留尿控结构的经尿道钬激光前列腺剜除术(HoLEP)和经尿道等离子前列腺剜除术(TUPKEP)在前列腺组织剥离及疗效上的差异。方法:310例良性前列腺增生(BPH)患者行HoLEP或TUPKEP手术,其中HoLEP组165例,TUPKEP组145例,术中尽最大可能保留尿道黏膜、前列腺前括约肌、前列腺被动括约肌,并尽量避免横纹括约肌(SS)等尿控结构的损伤。收集并统计学分析2种术式的围手术期和术后各项随访指标,评估尽最大可能保留尿控结构的HoLEP和TUPKEP的整体疗效及其在前列腺组织剥离上的差异。结果:310例BPH患者均顺利完成手术。两组所切除的腺体组织重量差异无统计学意义(P>0.05),术中出血量HoLEP组少于TUPKEP组(P<0.05)。两组总手术时间和腺体剥离时间的差异均无统计学意义(P>0.05),但HoLEP组腺体粉碎时间要明显少于TUPKEP组切块时间(P<0.05),且HoLEP组单位时间剜除效率及单位体积剜除效率更高(P<0.05)。此外,HoLEP组的膀胱冲洗时间、留置尿管时间及术后住院时间均更短(P<0.05)。两组术后国际前列腺症状评分(IPSS)、最大尿流率(Q_(max))、残余尿量(PVR)及其手术前后变化值差异均无统计学意义(P>0.05)。两组患者中均有暂时性的压力性尿失禁发生,其中HoLEP组26例(15.8%),TUPKEP组17例(11.7%),差异无统计学意义(P>0.05)。两组感染、发热及尿道狭窄的发生率差异无统计学意义(P>0.05)。但HoLEP组患者拔除尿管后的尿潴留及术后再出血发生率均更低(P<0.05)。结论:主动保留尿控结构的HoLEP与TUPKEP均取得较好的效果,二者疗效相当,但HoLEP剜除效率相对更高,止血及防止再出血效果更好,对尿控的保护程度更高,术后恢复速度也更快。因此,其在前列腺组织剥离方法上具有更好的优势。
Objective:To explore the difference between HoLEP and TUPKEP with actively retaining urinary control structure in prostate tissue stripping and efficacy.Method:Three hundred and ten prostate hyperplasia patients were enrolled including 165 patients undergoing HoLEP and 145 patients undergoing TUPKEP.The urethral mucosa,the preprostatic sphincter and the prostatic passive sphincter were preserved to the greatest extent during the operation,and the damage of the urinary control structure such as the prostatic striated sphincter was avoided as much as possible.The perioperative and postoperative follow-up indicators of the two procedures were collected and statistically analyzed to assess the overall efficacy and the difference in prostate tissue stripping with preserving urinary control structure to the greatest extent.Result:The operation of 310 patients with BPH were successfully completed.There was no significant difference in the weight of the resected gland between the two groups(P >0.05).However,the blood loss in HoLEP group was less(P <0.05).There was no significant difference in total operation time or gland stripping time(P>0.05).Howerver,the morcellation time in HoLEP group was significantly less than that of the TUPKEP group(P<0.05).Moreover,the enucleation efficiency per unit time and per unit volume of HoLEP were higher(P<0.05).In addition,the HoLEP group had shorter bladder irrigation time,catheterization time and postoperative hospital stay(P <0.05).There was no significant difference in postoperative IPSS,Q_(max),PVR or postoperative changes(P>0.05).Temporary stress urinary incontinence occurred in both groups,including 26 cases(15.8%)in HoLEP group and 17 cases(11.7%)in TUPKEP group,with no statistical difference(P>0.05).The incidence of fever or urethral stricture was not significantly different(P>0.05).However,the incidence of urinary retention and postoperative rebleeding after removal of the catheter in the HoLEP group were lower(P<0.05).Conclusion:Both HoLEP and TUPKEP with actively retaining urinary control structure are effective.However,HoLEP is advantageous in hemostasis and preventing rehaemorrhagia,improving the postoperative problems of urine continence and getting fewer recovery period and more effective in enucleation.Therefore,HoLEP is better in stripping prostate tissue.
Objective:To explore the difference between HoLEP and TUPKEP with actively retaining urinary control structure in prostate tissue stripping and efficacy.Method:Three hundred and ten prostate hyperplasia patients were enrolled including 165 patients undergoing HoLEP and 145 patients undergoing TUPKEP.The urethral mucosa,the preprostatic sphincter and the prostatic passive sphincter were preserved to the greatest extent during the operation,and the damage of the urinary control structure such as the prostatic striated sphincter was avoided as much as possible.The perioperative and postoperative follow-up indicators of the two procedures were collected and statistically analyzed to assess the overall efficacy and the difference in prostate tissue stripping with preserving urinary control structure to the greatest extent.Result:The operation of 310 patients with BPH were successfully completed.There was no significant difference in the weight of the resected gland between the two groups(P >0.05).However,the blood loss in HoLEP group was less(P <0.05).There was no significant difference in total operation time or gland stripping time(P>0.05).Howerver,the morcellation time in HoLEP group was significantly less than that of the TUPKEP group(P<0.05).Moreover,the enucleation efficiency per unit time and per unit volume of HoLEP were higher(P<0.05).In addition,the HoLEP group had shorter bladder irrigation time,catheterization time and postoperative hospital stay(P <0.05).There was no significant difference in postoperative IPSS,Q_(max),PVR or postoperative changes(P>0.05).Temporary stress urinary incontinence occurred in both groups,including 26 cases(15.8%)in HoLEP group and 17 cases(11.7%)in TUPKEP group,with no statistical difference(P>0.05).The incidence of fever or urethral stricture was not significantly different(P>0.05).However,the incidence of urinary retention and postoperative rebleeding after removal of the catheter in the HoLEP group were lower(P<0.05).Conclusion:Both HoLEP and TUPKEP with actively retaining urinary control structure are effective.However,HoLEP is advantageous in hemostasis and preventing rehaemorrhagia,improving the postoperative problems of urine continence and getting fewer recovery period and more effective in enucleation.Therefore,HoLEP is better in stripping prostate tissue.
引文
1 Herrmann T R.Enucleation is enucleation is enucleation is enucleation[J].World J Urol,2016,34(10):1353-1355.
2 Marquette T,Comat V,Robert G.Endoscopic enucleation of the prostate:Indication,technique and results[J].Prog Urol,2017,27(14):836-840.
3 李海皓,王海峰,刘靖宇,等.术中主动保护尿控功能在经尿道前列腺钬激光剜除术中的应用疗效分析[J].临床泌尿外科杂志,2017,32(4):260-263.
4 Abou-Taleb A,El-Shaer W,Kandeel W,et al.Bipolar Plasmakinetic Enucleoresection of the Prostate:Our Experience with 245Patients for 3Years of Follow-Up[J].J Endourol,2017,31(3):300-306.
5 Herrmann T.Enucleation is enucleation is enucleation is enucleation[J].World J Urol,2016,34(10):1353-1355.
6 Michalak J,Tzou D,Funk J.HoLEP:the gold standard for the surgical management of BPH in the 21(st)Century[J].Am J Clin Exp Urol,2015,3(1):36-42.
7 杨帝宽,刘春晓.经尿道前列腺剜除术[J].中华腔镜泌尿外科杂志(电子版),2011,5(6):516-518.
8 刘春晓.经尿道前列腺解剖性剜除术的研究进展[J].微创医学,2015,10(3):263-268.
9 Comat V,Marquette T,Sutter W,et al.Day-Case Holmium Laser Enucleation of the Prostate:Prospective Evaluation of 90Consecutive Cases[J].J Endourol,2017,31(10):1056-1061.
10 Barboza L,Malafaia O,Slongo L,et al.Holmium Laser enucleation of the prostate(HoLEP)versus Transurethral Resection of the Prostate(TURP)[J].Rev Col Bras Cir,2015,42(3):165-170.
11 Qian X,Liu H,Xu D,et al.Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia:a review of the literature and Meta-analysis[J].Aging Male,2017,20(3):184-191.
12 郭强,肖毅,李建文,等.HoLEP与TUPKP治疗BPH的安全性和疗效的meta分析[J].中华男科学杂志,2016,22(10):914-922.
13 曾宪涛,翁鸿,王行环,等.中国良性前列腺增生症经尿道等离子双极电切术治疗指南(2018版)[J].中华医学杂志,2018,98(20):1549-1560.
14 Glybochko P V,Rapoport L M,Enikeev M E,et al.Holmium laser enucleation of the prostate(HoLEP)for small,large and giant prostatic hyperplasia:tips and tricks[J].Urologia,2017,84(3):169-173.
15 Neuville P,Codas R,Ravier E,et al.Anticoagulation impact on bleeding risk during HoLEP:Monocentric study of 156patients[J].Prog Urol,2018,28(2):128-134.
16 Sun J,Shi A,Tong Z,et al.Safety and feasibility study of holmium laser enucleation of the prostate(HOLEP)on patients receiving dual antiplatelet therapy(DAPT)[J].World J Urol,2018,36(2):271-276.
17 陈俊毅,陈东,王加良,等.经尿道前列腺等离子剜除术中保留尿控的策略[J].中华男科学杂志,2018,24(2):138-141.
18 Neill M G,Gilling P J,Kennett K M,et al.Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia[J].Urology,2006,68(5):1020-1024.
2 Marquette T,Comat V,Robert G.Endoscopic enucleation of the prostate:Indication,technique and results[J].Prog Urol,2017,27(14):836-840.
3 李海皓,王海峰,刘靖宇,等.术中主动保护尿控功能在经尿道前列腺钬激光剜除术中的应用疗效分析[J].临床泌尿外科杂志,2017,32(4):260-263.
4 Abou-Taleb A,El-Shaer W,Kandeel W,et al.Bipolar Plasmakinetic Enucleoresection of the Prostate:Our Experience with 245Patients for 3Years of Follow-Up[J].J Endourol,2017,31(3):300-306.
5 Herrmann T.Enucleation is enucleation is enucleation is enucleation[J].World J Urol,2016,34(10):1353-1355.
6 Michalak J,Tzou D,Funk J.HoLEP:the gold standard for the surgical management of BPH in the 21(st)Century[J].Am J Clin Exp Urol,2015,3(1):36-42.
7 杨帝宽,刘春晓.经尿道前列腺剜除术[J].中华腔镜泌尿外科杂志(电子版),2011,5(6):516-518.
8 刘春晓.经尿道前列腺解剖性剜除术的研究进展[J].微创医学,2015,10(3):263-268.
9 Comat V,Marquette T,Sutter W,et al.Day-Case Holmium Laser Enucleation of the Prostate:Prospective Evaluation of 90Consecutive Cases[J].J Endourol,2017,31(10):1056-1061.
10 Barboza L,Malafaia O,Slongo L,et al.Holmium Laser enucleation of the prostate(HoLEP)versus Transurethral Resection of the Prostate(TURP)[J].Rev Col Bras Cir,2015,42(3):165-170.
11 Qian X,Liu H,Xu D,et al.Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia:a review of the literature and Meta-analysis[J].Aging Male,2017,20(3):184-191.
12 郭强,肖毅,李建文,等.HoLEP与TUPKP治疗BPH的安全性和疗效的meta分析[J].中华男科学杂志,2016,22(10):914-922.
13 曾宪涛,翁鸿,王行环,等.中国良性前列腺增生症经尿道等离子双极电切术治疗指南(2018版)[J].中华医学杂志,2018,98(20):1549-1560.
14 Glybochko P V,Rapoport L M,Enikeev M E,et al.Holmium laser enucleation of the prostate(HoLEP)for small,large and giant prostatic hyperplasia:tips and tricks[J].Urologia,2017,84(3):169-173.
15 Neuville P,Codas R,Ravier E,et al.Anticoagulation impact on bleeding risk during HoLEP:Monocentric study of 156patients[J].Prog Urol,2018,28(2):128-134.
16 Sun J,Shi A,Tong Z,et al.Safety and feasibility study of holmium laser enucleation of the prostate(HOLEP)on patients receiving dual antiplatelet therapy(DAPT)[J].World J Urol,2018,36(2):271-276.
17 陈俊毅,陈东,王加良,等.经尿道前列腺等离子剜除术中保留尿控的策略[J].中华男科学杂志,2018,24(2):138-141.
18 Neill M G,Gilling P J,Kennett K M,et al.Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia[J].Urology,2006,68(5):1020-1024.