中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2014年
5期
349-353
,共5页
王忠%陈彦博%陈其%蔡志康%姚海军%郑大超%周娟%彭御冰
王忠%陳彥博%陳其%蔡誌康%姚海軍%鄭大超%週娟%彭禦冰
왕충%진언박%진기%채지강%요해군%정대초%주연%팽어빙
前列腺增生%经尿道手术%等离子切除%钬激光剜除
前列腺增生%經尿道手術%等離子切除%鈥激光剜除
전렬선증생%경뇨도수술%등리자절제%화격광완제
Benign prostatic hyperplasia%Transurethral surgery%Plasma kinetic resection%Holmium laser enucleation
目的 比较经尿道前列腺等离子切除术(plasma kinetic resection of the prostate,PKRP)与经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)治疗BPH的疗效和安全性. 方法 回顾性分析2008年8月至2012年6月收治的812例BPH患者的临床资料.PKRP组410例,HoLEP组402例,两组患者的年龄[(71.9±8.2)岁与(72.8±8.6)岁]、前列腺体积[(61.2±23.3) ml与(58.8±29.5)ml]、IPSS评分(23.8±3.6与23.5±3.7)、QOL评分(4.5±0.7与4.4±0.7)、Qmax[(7.1±3.3) ml/s与(7.1±3.4) ml/s]、IIEF-5评分(18.4±3.5与18.2±3.4)比较差异均无统计学意义(P＞0.05).比较两种手术方式的安全性和疗效. 结果 术后随访6个月,PKRP组和HoLEP组的IPSS(6.3±1.7与6.2±1.9)、QOL评分(1.8±0.7与1.0±0.6)及Qmax[(23.9±4.5) ml/s与(23.9±4.2) ml/s]差异均无统计学意义(P＞0.05),但两组较术前均有所改善,差异有统计学意义(P＜0.05).HoLEP组与PKRP组的手术时间[(87.1±41.9) min与(60.5±±19.6)min]、切除组织质量[(55.2±16.5)g与(43.9±15.8)g]、术后血红蛋白下降值[(1.2±0.6)g/L与(1.8±0.7) g/L]、膀胱冲洗时间[(22.8±11.8)h与(30.4±14.4)h]、导尿管留置时间[(74.2±24.5)h与(89.1±32.3) h]和住院时间[(4.1±1.9)d与(5.4±3.0)d]比较差异均有统计学意义(P＜0.05).两组术后均未发生经尿道电切综合征,PKRP组10例和HoLEP组5例术后拔除导尿管后发生尿潴留,再次留置导尿管3～5d拔管,均能自行排尿.PKRP组中4例因术后出血给予输血治疗,HoLEP组无输血病例.PKRP组30例和HoLEP组35例出现不同程度的压力性尿失禁,术后1～6个月内排尿恢复正常.PKRP组4例和HoLEP组2例因尿道狭窄或膀胱颈硬化需要再次手术切开治疗.在仍有性生活的患者中,PKRP组45例和HoLEP组49例出现逆行射精.两组的尿潴留、输血、再次手术、压力性尿失禁及逆行射精等发生率比较差异无统计学意义(P＞0.05).PKRP组99例和HoLEP组102例进行了IIEF-5评分随访,两组术后未出现明显的勃起功能障碍,两组间IIEF-5评分比较差异无统计学意义(P＞0.05). 结论 PKRP及HoLEP治疗BPH均具有良好的疗效及安全性.对于有TURP手术禁忌证的部分患者,可以考虑采用HoLEP手术,出血风险更小,膀胱冲洗、留置导尿及住院时间更短.
目的 比較經尿道前列腺等離子切除術(plasma kinetic resection of the prostate,PKRP)與經尿道前列腺鈥激光剜除術(holmium laser enucleation of the prostate,HoLEP)治療BPH的療效和安全性. 方法 迴顧性分析2008年8月至2012年6月收治的812例BPH患者的臨床資料.PKRP組410例,HoLEP組402例,兩組患者的年齡[(71.9±8.2)歲與(72.8±8.6)歲]、前列腺體積[(61.2±23.3) ml與(58.8±29.5)ml]、IPSS評分(23.8±3.6與23.5±3.7)、QOL評分(4.5±0.7與4.4±0.7)、Qmax[(7.1±3.3) ml/s與(7.1±3.4) ml/s]、IIEF-5評分(18.4±3.5與18.2±3.4)比較差異均無統計學意義(P＞0.05).比較兩種手術方式的安全性和療效. 結果 術後隨訪6箇月,PKRP組和HoLEP組的IPSS(6.3±1.7與6.2±1.9)、QOL評分(1.8±0.7與1.0±0.6)及Qmax[(23.9±4.5) ml/s與(23.9±4.2) ml/s]差異均無統計學意義(P＞0.05),但兩組較術前均有所改善,差異有統計學意義(P＜0.05).HoLEP組與PKRP組的手術時間[(87.1±41.9) min與(60.5±±19.6)min]、切除組織質量[(55.2±16.5)g與(43.9±15.8)g]、術後血紅蛋白下降值[(1.2±0.6)g/L與(1.8±0.7) g/L]、膀胱遲洗時間[(22.8±11.8)h與(30.4±14.4)h]、導尿管留置時間[(74.2±24.5)h與(89.1±32.3) h]和住院時間[(4.1±1.9)d與(5.4±3.0)d]比較差異均有統計學意義(P＜0.05).兩組術後均未髮生經尿道電切綜閤徵,PKRP組10例和HoLEP組5例術後拔除導尿管後髮生尿潴留,再次留置導尿管3～5d拔管,均能自行排尿.PKRP組中4例因術後齣血給予輸血治療,HoLEP組無輸血病例.PKRP組30例和HoLEP組35例齣現不同程度的壓力性尿失禁,術後1～6箇月內排尿恢複正常.PKRP組4例和HoLEP組2例因尿道狹窄或膀胱頸硬化需要再次手術切開治療.在仍有性生活的患者中,PKRP組45例和HoLEP組49例齣現逆行射精.兩組的尿潴留、輸血、再次手術、壓力性尿失禁及逆行射精等髮生率比較差異無統計學意義(P＞0.05).PKRP組99例和HoLEP組102例進行瞭IIEF-5評分隨訪,兩組術後未齣現明顯的勃起功能障礙,兩組間IIEF-5評分比較差異無統計學意義(P＞0.05). 結論 PKRP及HoLEP治療BPH均具有良好的療效及安全性.對于有TURP手術禁忌證的部分患者,可以攷慮採用HoLEP手術,齣血風險更小,膀胱遲洗、留置導尿及住院時間更短.
목적 비교경뇨도전렬선등리자절제술(plasma kinetic resection of the prostate,PKRP)여경뇨도전렬선화격광완제술(holmium laser enucleation of the prostate,HoLEP)치료BPH적료효화안전성. 방법 회고성분석2008년8월지2012년6월수치적812례BPH환자적림상자료.PKRP조410례,HoLEP조402례,량조환자적년령[(71.9±8.2)세여(72.8±8.6)세]、전렬선체적[(61.2±23.3) ml여(58.8±29.5)ml]、IPSS평분(23.8±3.6여23.5±3.7)、QOL평분(4.5±0.7여4.4±0.7)、Qmax[(7.1±3.3) ml/s여(7.1±3.4) ml/s]、IIEF-5평분(18.4±3.5여18.2±3.4)비교차이균무통계학의의(P＞0.05).비교량충수술방식적안전성화료효. 결과 술후수방6개월,PKRP조화HoLEP조적IPSS(6.3±1.7여6.2±1.9)、QOL평분(1.8±0.7여1.0±0.6)급Qmax[(23.9±4.5) ml/s여(23.9±4.2) ml/s]차이균무통계학의의(P＞0.05),단량조교술전균유소개선,차이유통계학의의(P＜0.05).HoLEP조여PKRP조적수술시간[(87.1±41.9) min여(60.5±±19.6)min]、절제조직질량[(55.2±16.5)g여(43.9±15.8)g]、술후혈홍단백하강치[(1.2±0.6)g/L여(1.8±0.7) g/L]、방광충세시간[(22.8±11.8)h여(30.4±14.4)h]、도뇨관류치시간[(74.2±24.5)h여(89.1±32.3) h]화주원시간[(4.1±1.9)d여(5.4±3.0)d]비교차이균유통계학의의(P＜0.05).량조술후균미발생경뇨도전절종합정,PKRP조10례화HoLEP조5례술후발제도뇨관후발생뇨저류,재차류치도뇨관3～5d발관,균능자행배뇨.PKRP조중4례인술후출혈급여수혈치료,HoLEP조무수혈병례.PKRP조30례화HoLEP조35례출현불동정도적압력성뇨실금,술후1～6개월내배뇨회복정상.PKRP조4례화HoLEP조2례인뇨도협착혹방광경경화수요재차수술절개치료.재잉유성생활적환자중,PKRP조45례화HoLEP조49례출현역행사정.량조적뇨저류、수혈、재차수술、압력성뇨실금급역행사정등발생솔비교차이무통계학의의(P＞0.05).PKRP조99례화HoLEP조102례진행료IIEF-5평분수방,량조술후미출현명현적발기공능장애,량조간IIEF-5평분비교차이무통계학의의(P＞0.05). 결론 PKRP급HoLEP치료BPH균구유량호적료효급안전성.대우유TURP수술금기증적부분환자,가이고필채용HoLEP수술,출혈풍험경소,방광충세、류치도뇨급주원시간경단.
Objective To compare the safety and efficacy of the two surgical approaches,plasma kinetic resection of the prostate (PKRP) versus holmium laser enucleation of the prostate (HoLEP),in the treatment of benign prostate hyperplasia (BPH).Methods From August 2008 to June 2012,retrospective analysis were made of 812 BPH cases,including 410 treated by PKRP (PKRP group) and 402 by HoLEP (HoLEP group).No significant differences were observed in the pre-operative data [age:(71.9± 8.2) year vs (72.8±8.6) year,P＞0.05; prostate volume:(61.2±23.3)ml vs (58.8±29.5) ml,P＞0.05; IPSS scores (23.8±3.6) vs (23.5±3.7),P＞0.05; QOL scores (4.5±0.7) vs (4.4t0.7),Qmax:(7.1± 3.3) ml/s vs (7.1±3.4) ml.s,P＞0.05 and IIEF-5 scores (18.4±3.5) vs (18.2±3.4),P＞0.05] between two groups.The safety and efficacy of the two approaches were assessed based on the peri-and postoperative outcome data and follow-up data.Results Both groups displayed significant improvements in IPSS (PKRP group:(23.8±3.6) vs (6.3±1.7) ; HoLEP group:(23.5±3.7) vs (6.2±1.9),P＜0.05),QOL (PKRP group:(4.5±0.7) vs (1.8±0.7); HoLEP group:(4.4±0.7) vs (1.0±0.6),P＜0.05) and Qmax (PKRP group:(7.1±3.3) ml/s vs (23.9±4.5) ml/s; HoLEP group:(7.1±3.4) ml/s vs (23.9±4.2) ml/s,P＜0.05) 6 month after surgery.However,we identified there was no significant differences between the two groups in the follow-up data (P＞0.05).There was no significant difference compared with preoperative IIEF-5 and between both groups after surgery.Patients in the HoLEP group displayed lower risk of haemorrhage (Haemoglobin decrease:(1.2±0.6) g/dL vs (1.8±0.7) g/dL (P＜0.01),shorter bladder irrigation (22.8± 11.8) h vs (30.4±14.4) h (P＜0.01) and shorter catheter indwelling (4.1±1.9) d vs (5.4±3.0) d (P＜ 0.01) as well as shorter hospital stays (4.1±1.9) d vs (5.4±3.0) d (P＜0.01).A larger amount of prostate tissue was retrieved in the HoLEP group (55.2±16.5) g vs (43.9±15.8) g (P＜0.05),but the operative time was longer in this group than that in the PKRP group (87.1±41.9) min vs (60.5±19.6) min (P＜ 0.01).No TUR syndrome was detected in both groups.10 patients needed re-catheterization due to urine retention after catheter removal in the PKRP group,while 5 in the HoLEP group required re-catheterization.But the catheters were all removed after 3-5 d.4 patients required blood transfusion in the PKRP group because of blood loss after the operation while none in the HoLEP group.The incontinence presented in both groups (30 in the PKRP and 35 in the HoLEP group),but all patients recovered within 1-6 months.Re-operations due to the urethral stricture and bladder neck contracture were needed in 4 patients of the PKRP group and in 2 of the HoLEP group.In patients who still had sexual active,retrograde ejaculation was reported by 45 patients in the PKRP group and 49 patients in the HoLEP group.There was no significant difference in the rate of postoperative urinary retention,blood transfusion,reoperation,incidence of stress urinary incontinence and retrograde ejaculation(P＞0.05).IIEF-5 was also recorded,which was completed by 99 in PKRP group and 102 in HoLEP group.The result showed that there was no significant reduction in erectile function after operation in either group and there was no significant difference in both groups (P＞0.05).Conclusions Both PKRP and HoLEP shows effective and safe in the treatment of BPH.HoLEP provides more widely application range,especially in patients with some contraindications,less risk of haemorrhage,reduced bladder irrigation and catheter indwelling duration as well as reduced hospital stay.
