经尿道前列腺钬激光剜除术与经尿道前列腺双极等离子剜除术治疗良性前列腺增生的近期疗效比较
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摘要
目的比较经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,Ho LEP)与经尿道前列腺双极等离子剜除术(plasmakinetic enucleation of the prostate,PKEP)治疗良性前列腺增生(benign prostatic hyperlasia,BPH)的近期疗效。方法采用随机数字表法,将60例BPH患者分为两组,分别行Ho LEP及PKEP,对术中和术后数据进行收集,在随访中记录两组患者国际前列腺症状评分(IPSS)、生活质量指数评分(QOL)、最大尿流率(Qmax)和膀胱残余尿量(PVR)的情况。结果 Ho LEP组和PKEP组平均手术时间分别为(47. 6±7. 1) min和(74. 2±9. 7) min,膀胱冲洗时间分别为(9. 3±2. 1) h和(16. 7±4. 3) h,平均留置导尿管时间分别为(72. 8±5. 1) h和(79. 6±5. 4) h,平均住院时间分别为(5. 9±1. 7) d和(8. 8±1. 5) d,血红蛋白分别下降(7. 0±1. 3) g/L和(9. 6±1. 7) g/L,差异均有统计学意义(P <0. 05)。两组前列腺切除组织重量、并发症发生率差异无统计学意义(P> 0. 05)。两组患者间术前IPSS、QOL、Qmax、PVR与术后6个月差异无统计学意义(P> 0. 05)。结论与PKEP组相比,Ho LEP组出血量更少,手术时间、膀胱冲洗时间、住院时间更短。Ho LEP可能成为BPH手术治疗的首选方法。
Objective To compare the short-term curative effects of holmium laser enucleation of the prostate( Ho LEP) vs plasmakinetic enucleation of the prostate( PKEP) in treatment of benign prostatic hyperplasia( BPH).Methods Sixty cases of BPH were randomly divided into Ho LEP group( treated with Ho LEP) and PKEP group( treated with PKEP) by random number table method. The relevant data were collected during and after operation. IPSS,QOL,Qmax and PVR were recorded during the follow-up period. Results There were significant differences between Ho LEP group and PKEP group in the mean duration of operation[( 47. 6 ± 7. 1) min vs( 74. 2 ± 9. 7) min],in bladder washing time[( 9. 3 ± 2. 1) h vs( 16. 7 ± 4. 3) h],in the mean time of indwelling catheter[( 72. 8 ± 5. 1) h vs( 79. 6 ±5. 4) h],in the mean duration of hospitalization[( 5. 9 ± 1. 7) d vs( 8. 8 ± 1. 5) d],and in the decrease of hemoglobin[( 7. 0 ±1. 3) g/L vs( 9. 6 ± 1. 7) g/L]( P < 0. 05). There were no significant differences in the mass of the excised prostates and the incidence of complications between the two groups( P > 0. 05). There were no significant differences in IPSS,QOL,Qmax and PVR before and 6 months after operation between the two groups( P > 0. 05). Conclusion Compared with PKEP group,Ho LEP group has less bleeding,shorter operation time,bladder washing time and hospitalization time in the treatment of BPH. Ho LEP may be the primary method of surgieal treatment for BPH.
Objective To compare the short-term curative effects of holmium laser enucleation of the prostate( Ho LEP) vs plasmakinetic enucleation of the prostate( PKEP) in treatment of benign prostatic hyperplasia( BPH).Methods Sixty cases of BPH were randomly divided into Ho LEP group( treated with Ho LEP) and PKEP group( treated with PKEP) by random number table method. The relevant data were collected during and after operation. IPSS,QOL,Qmax and PVR were recorded during the follow-up period. Results There were significant differences between Ho LEP group and PKEP group in the mean duration of operation[( 47. 6 ± 7. 1) min vs( 74. 2 ± 9. 7) min],in bladder washing time[( 9. 3 ± 2. 1) h vs( 16. 7 ± 4. 3) h],in the mean time of indwelling catheter[( 72. 8 ± 5. 1) h vs( 79. 6 ±5. 4) h],in the mean duration of hospitalization[( 5. 9 ± 1. 7) d vs( 8. 8 ± 1. 5) d],and in the decrease of hemoglobin[( 7. 0 ±1. 3) g/L vs( 9. 6 ± 1. 7) g/L]( P < 0. 05). There were no significant differences in the mass of the excised prostates and the incidence of complications between the two groups( P > 0. 05). There were no significant differences in IPSS,QOL,Qmax and PVR before and 6 months after operation between the two groups( P > 0. 05). Conclusion Compared with PKEP group,Ho LEP group has less bleeding,shorter operation time,bladder washing time and hospitalization time in the treatment of BPH. Ho LEP may be the primary method of surgieal treatment for BPH.
引文
1何恒.前列腺电切术与经尿道前列腺钬激光剜除术的疗效对比[J].中外医疗,2016,35(8):85-86.
2王忠,陈彦博,陈其,等.经尿道前列腺等离子切除术与钬激光剜除术治疗良性前列腺增生的疗效和安全性比较[J].中华泌尿外科杂志,2014,35(5):349-353.
3吴阶平.吴阶平泌尿外科学[M].济南:山东科学技术出版社,2004:1150.
4那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:253-260.
5刘春晓.传统经尿道前列腺电切术不应再是前列腺增生腔内治疗的金标准[J].现代泌尿外科杂志,2012,17(3):298-299.
6 Rassweiler J,Teber D,Kuntz R,et al.Complications of transurethral resection of the prostate(TURP)-incidence,management,and prevention[J].Eur Urol,2006,50(5):969-979.
7 Varkarakis J,Bartsch G,Horninger W.Long-term morbidity and mortality of transurethral prostatectomy:a 10-year follow-up[J].Prostate,2004,58(3):248-251.
8卞军,刘春晓,郑少波,等.经尿道前列腺等离子腔内剜除术与切除术治疗前列腺增生的临床对照研究[J].南方医科大学学报,2008,28(5):742-745.
9 Liu C,Zheng S,Li H,et al.Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics[J].J Urol,2010,184(6):2440-2445.
10 Zhang KY,Xing JC,Chen BS,et al.Bipolar plasmakinetic transurethral resection of the prostate vs.transurethral enucleation and resection of the prostate:pre-and postoperative comparisons of parameters used in assessing benign prostatic enlargement[J].Singapore Med J,2011,52(10):747-751.
11刘俊峰,谭朝晖,李三祥,等.经尿道双极等离子前列腺剜除术与经尿道双极等离子电切术比较治疗前列腺增生的临床研究[J].中国循证医学杂志,2013,13(12):1405-1408.
12 Giilling PJ,Kennett K,Das AK,et al.Holmium laser enucleation of the prostate(Ho LEP)combined with transurethral tissue morcellation:an update on the early clinical experience[J].J Endourol,1998,12(5):457-459.
13 Chen YB,Chen Q,Wang Z,et al.A prospective,randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup[J].J Urol,2013,189(1):217-222.
14 Mavuduru RM,Mandal AK,Singh SK,et al.Comparison of HoLEP and TURP in Terms of efficacy in the early postoperative period and perioperative morbidity[J].Urol Int,2009,82(2):130-135.
15 Endo F,Shiga Y,Minagawa S,et al.Anteroposterior dissection Ho LEP:a modification to prevent transient stress urinary incontinence[J].Urology,2010,76(6):1451-1455.
2王忠,陈彦博,陈其,等.经尿道前列腺等离子切除术与钬激光剜除术治疗良性前列腺增生的疗效和安全性比较[J].中华泌尿外科杂志,2014,35(5):349-353.
3吴阶平.吴阶平泌尿外科学[M].济南:山东科学技术出版社,2004:1150.
4那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:253-260.
5刘春晓.传统经尿道前列腺电切术不应再是前列腺增生腔内治疗的金标准[J].现代泌尿外科杂志,2012,17(3):298-299.
6 Rassweiler J,Teber D,Kuntz R,et al.Complications of transurethral resection of the prostate(TURP)-incidence,management,and prevention[J].Eur Urol,2006,50(5):969-979.
7 Varkarakis J,Bartsch G,Horninger W.Long-term morbidity and mortality of transurethral prostatectomy:a 10-year follow-up[J].Prostate,2004,58(3):248-251.
8卞军,刘春晓,郑少波,等.经尿道前列腺等离子腔内剜除术与切除术治疗前列腺增生的临床对照研究[J].南方医科大学学报,2008,28(5):742-745.
9 Liu C,Zheng S,Li H,et al.Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics[J].J Urol,2010,184(6):2440-2445.
10 Zhang KY,Xing JC,Chen BS,et al.Bipolar plasmakinetic transurethral resection of the prostate vs.transurethral enucleation and resection of the prostate:pre-and postoperative comparisons of parameters used in assessing benign prostatic enlargement[J].Singapore Med J,2011,52(10):747-751.
11刘俊峰,谭朝晖,李三祥,等.经尿道双极等离子前列腺剜除术与经尿道双极等离子电切术比较治疗前列腺增生的临床研究[J].中国循证医学杂志,2013,13(12):1405-1408.
12 Giilling PJ,Kennett K,Das AK,et al.Holmium laser enucleation of the prostate(Ho LEP)combined with transurethral tissue morcellation:an update on the early clinical experience[J].J Endourol,1998,12(5):457-459.
13 Chen YB,Chen Q,Wang Z,et al.A prospective,randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup[J].J Urol,2013,189(1):217-222.
14 Mavuduru RM,Mandal AK,Singh SK,et al.Comparison of HoLEP and TURP in Terms of efficacy in the early postoperative period and perioperative morbidity[J].Urol Int,2009,82(2):130-135.
15 Endo F,Shiga Y,Minagawa S,et al.Anteroposterior dissection Ho LEP:a modification to prevent transient stress urinary incontinence[J].Urology,2010,76(6):1451-1455.