CAJ | 학술논문

目的比较经尿道前列腺红激光剜除术(diode laser enucleation of the prostate,DiLEP)和经尿道前列腺等离子剜除术(bipolar plasmakinetic enucleation of the prostate,PKEP)治疗大体积良性前列腺增生(benign prostatic hyperplasia,BPH)的疗效及安全性.方法回顾性分析2012年6月到2014年1月收治的70例大体积BPH患者,分别采用等离子或红激光行经尿道前列腺剜除术.比较两组手术时间、血红蛋白值下降值、手术前后国际前列腺症状评分(IPSS)、残尿量(PVR)、最大尿流率(Qmax).结果两组手术均获成功;术后随访12个月,两组IPSS、Qmax、生活质量评分(QoL)无差异.DiLEP组术后血红蛋白下降值、膀胱灌注时间、留置尿管时间及住院时间均显著低于PKEP组.两组手术时间[(123.5±27.2)min vs.(102.7±20.4)min]、切除组织重量[(64.7±16.8)g vs.(61.2±20.5)g]、术后血红蛋白下降值[(0.92±0.43)g/dl vs.(1.24±0.55)g/dl]、膀胱灌注时间[(28.9±14)h vs.(38.5±16.6)h]、导尿管留置时间[(2.6±1.8)d vs.(3.8±2.3)d]和住院时间[(4.84±1.8)d vs.(6.2±2.3)d]比较差异均有统计学意义(P<0.05);刺激症状、逆行射精亦有差异(P<0.05);但尿潴留、输血、压力性尿失禁发生率无差别;且术后均未发生经尿道电切综合征.PKEP组1例因术后出血给予输血治疗.结论与PKEP相比,DiLEP治疗大体积BPH出血风险更小,膀胱灌注、留置尿管及住院时间更短,具有良好的疗效及安全性.
목적 비교경뇨도전렬선홍격광완제술(diode laser enucleation of the prostate,DiLEP)화경뇨도전렬선등리자완제술(bipolar plasmakinetic enucleation of the prostate,PKEP)치료대체적량성전렬선증생(benign prostatic hyperplasia,BPH)적료효급안전성.방법 회고성분석2012년6월도2014년1월수치적70례대체적BPH환자,분별채용등리자혹홍격광행경뇨도전렬선완제술.비교량조수술시간、혈홍단백치하강치、수술전후국제전렬선증상평분(IPSS)、잔뇨량(PVR)、최대뇨류솔(Qmax).결과 량조수술균획성공;술후수방12개월,량조IPSS、Qmax、생활질량평분(QoL)무차이.DiLEP조술후혈홍단백하강치、방광관주시간、류치뇨관시간급주원시간균현저저우PKEP조.량조수술시간[(123.5±27.2)min vs.(102.7±20.4)min]、절제조직중량[(64.7±16.8)g vs.(61.2±20.5)g]、술후혈홍단백하강치[(0.92±0.43)g/dl vs.(1.24±0.55)g/dl]、방광관주시간[(28.9±14)h vs.(38.5±16.6)h]、도뇨관류치시간[(2.6±1.8)d vs.(3.8±2.3)d]화주원시간[(4.84±1.8)d vs.(6.2±2.3)d]비교차이균유통계학의의(P<0.05);자격증상、역행사정역유차이(P<0.05);단뇨저류、수혈、압력성뇨실금발생솔무차별;차술후균미발생경뇨도전절종합정.PKEP조1례인술후출혈급여수혈치료.결론 여PKEP상비,DiLEP치료대체적BPH출혈풍험경소,방광관주、류치뇨관급주원시간경단,구유량호적료효급안전성.
Objective To compare the safety and efficiency of diode laser enucleation with that of bipolar plasmakinetic enucleation for the treatment of large volume prostate(>80 ml). Methods From June 2012 to January 2014, A total of 70 patients with lower urinary tract symptoms associated with large volume prostate were included in our study. Of them,35 patients were treated with diode laser enucleation of the prostate (DiLEP). No significant differences were observed in the pre-operative data. All patients were preoperatively assessed and evaluated at months 3,6,and 12. Perioperative data and postoperative outcomes were compared. Immediate and late complications were also assessed. Results Both groups displayed significant improvements in international prostate symptom score, the quality of life, and the maximum flowrate 12 month after surgery. However,we identified there was no significant differences between the two groups in the follow-up data(P>0.05). Patients treated with diode laser showed a lower risk of blood loss [(0.92 ± 0.43)g/dl vs. (1.24 ± 0.55) g/dl],as well as shorter bladder irrigation [(28.9±14)h vs.(38.5±16.6)h] and catheterization times [(2.6±1.8)d vs.(3.8±2.3)d]. A larger amount of prostate tissue was retrieved in the DiLEP group,but the operation time of the diode laser group was longer than that of the bipolar plasmakinetic enucleation group [(123.5 ± 27.2) min vs. (102.7 ± 20.4)min]. There was no significant difference in the rate of postoperative urinary retention,blood transfusion,reoperation and incidence of stress urinary incontinence (P>0.05). However,the diode laser group was significantly superior to bipolar plasmakinetic group in terms of the irritative symptoms and ejaculatory function in the postoperative period. Conclusions DiLEP provides more widely application range,less risk of haemorrhage,reduced bladder irrigation and catheter indwelling duration as well as reduced hospital stay. Diode laser enucleation of the prostate is a safe and effective method for the transurethral management of prostates larger than 80 ml.