钬激光剜除与经典经尿道前列腺切除术在逼尿肌功能不全患者中手术结果的比较

doi:10.3877/cma.j.issn.1674-6899.2017.03.008

目的

比较逼尿肌功能不全(detrusor underactivity，DU)患者钬激光剜除术(holmium laser enucleation of the prostate，HoLEP)和经尿道前列腺切除术(transurethral resection of prostate，TURP)的短期手术结果。

方法

回顾性分析新疆维吾尔自治区人民医院2010年1月至2015年5月，352例患者接受单一外科治疗组医师进行HoLEP或TURP。其中56例患有良性前列腺增生症和DU的患者参与了本研究(HoLEP组，24例；TURP组，32例)。回顾性比较两组的术后结果。DU被定义为通过压力流率研究测量的最大流速时逼尿肌压力小于40 cmH₂O。

结果

两组患者的术前特征和合并症相似。TURP组的手术时间明显短于HoLEP组(P＝0.033)。HoLEP组切除的前列腺重量较大，HoLEP组的术后排尿参数(包括峰值流量和尿后残余尿量)明显优于TURP组。

结论

HoLEP可以在DU患者中有效且安全地进行，并且在下尿路症状改善方面预期手术结果比TURP好。

关键词: 良性前列腺增生, 经尿道前列腺切除, 钬激光器

Objective

To compared the short-term surgical outcomes of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) in patients with detrusor underactivity (DU).

Methods

Retrospectively analysis from Jan. 2010 to May 2015, 352 patients underwent HoLEP or TURP in procedures performed by a single surgeon. Of these patients, 56 patients with both BPH and DU were enrolled in this study (HoLEP, n=24; TURP, n=32). Surgical outcomes were retrospectively compared between the two groups. DU was defined as a detrusor pressure at maximal flow rate of < 40 cmH₂O as measured by a pressure flow study.

Results

The preoperative characteristics of patients and the presence of comorbidities were comparable between the 2 groups.The TURP group showed a significantly shorter operative time than the HoLEP group (P=0.033). The weight of the resected prostate was greater in the HoLEP group, and postoperative voiding parameters, including peak flow rate and postvoid residual urine volume were significantly better in the HoLEP group than in the TURP group.

Conclusions

HoLEP can be effectively and safely performed in patients with DU and can be expected to have better surgical outcomes than TURP in terms of the improvement in lower urinary tract symptoms.

Key words: Prostatic hyperplasia, Transurethral resection of prostate, Holmium lasers

表1 良性前列腺增生症合并逼尿肌功能不全患者的两组基线特征的比较( ±s )

组别	例数	年龄(年)	前列腺体积(ml)^a	术前IPSS评分(分)	排尿症状评分(分)	储尿症状评分(分)	最大尿流量(ml / s)	残余尿量(ml)	Pdet Qmax(cmH₂O)
HoLEP组	24	66.9±7.0	58.0±17.8	18.7±6.2	11.1±4.6	7.5±3.4	7.4±3.0	113.0±128.0	34.4±6.5
TURP组	32	71.4±5.6	54.2±13.9	18.7±6.2	9.0±4.8	6.7±3.3	6.3±3.9	151.0±118.0	33.1±10.0
P值	?	0.274	0.386	0.120	0.104	0.348	0.212	0.258	0.575

表1 良性前列腺增生症合并逼尿肌功能不全患者的两组基线特征的比较( ±s )

组别	例数	年龄(年)	前列腺体积(ml)^a	术前IPSS评分(分)	排尿症状评分(分)	储尿症状评分(分)	最大尿流量(ml / s)	残余尿量(ml)	Pdet Qmax(cmH₂O)
HoLEP组	24	66.9±7.0	58.0±17.8	18.7±6.2	11.1±4.6	7.5±3.4	7.4±3.0	113.0±128.0	34.4±6.5
TURP组	32	71.4±5.6	54.2±13.9	18.7±6.2	9.0±4.8	6.7±3.3	6.3±3.9	151.0±118.0	33.1±10.0
P值	?	0.274	0.386	0.120	0.104	0.348	0.212	0.258	0.575

表2 良性前列腺增生症合并逼尿肌功能不全患者的两组围手术期手术结果的比较( ±s)

组别	例数	切除体积(g)	手术时间(min)	血红蛋白损失(g/dl)	术后导尿时间(d)	住院时间(d)
HoLEP组	24	39.0 ± 17.7	90.2 ± 15.0	1.2 ± 0.6	3.3 ± 0.6	4.3 ± 0.6
TURP组	32	25.0 ± 7.8	78.8 ± 23.9	1.7 ± 0.9	4.5 ± 1.0	5.5 ± 1.0
P值	?	0.001	0.001	0.001	<0.001	<0.001

表2 良性前列腺增生症合并逼尿肌功能不全患者的两组围手术期手术结果的比较( ±s)

组别	例数	切除体积(g)	手术时间(min)	血红蛋白损失(g/dl)	术后导尿时间(d)	住院时间(d)
HoLEP组	24	39.0 ± 17.7	90.2 ± 15.0	1.2 ± 0.6	3.3 ± 0.6	4.3 ± 0.6
TURP组	32	25.0 ± 7.8	78.8 ± 23.9	1.7 ± 0.9	4.5 ± 1.0	5.5 ± 1.0
P值	?	0.001	0.001	0.001	<0.001	<0.001

表3 良性前列腺增生症合并逼尿肌功能不全患者的两组术后6个月并发症比较[例(%)]

组别	例数	输血	再次导尿	尿道狭窄	压力性尿失禁
HoLEP组	24	0 (0)	0 (0)	0 (0)	1 (4.2)
TURP组	32	1 (3.1)	1 (3.1)	2 (6.3)	0 (0)
P值	?	0.382	0.382	0.212	0.244

表3 良性前列腺增生症合并逼尿肌功能不全患者的两组术后6个月并发症比较[例(%)]

组别	例数	输血	再次导尿	尿道狭窄	压力性尿失禁
HoLEP组	24	0 (0)	0 (0)	0 (0)	1 (4.2)
TURP组	32	1 (3.1)	1 (3.1)	2 (6.3)	0 (0)
P值	?	0.382	0.382	0.212	0.244

表4 良性前列腺增生症合并逼尿肌功能不全患者的两组术后排尿状态比较( ±s)

组别	例数	术后IPSS评分(分)	排尿症状评分(分)	储尿症状评分(分)	最大尿流量(ml / s)	术后残余尿量(ml)	总IPSS评分^Δ(分)	排尿症状评分^Δ(分)	储尿症状评分^Δ(分)
HoLEP组	24	10.7±5.4	4.7±3.7	6.1±3.5	18.5±7.1	13.75±41.7	8.0±7.4	6.5±5.8	1.5±3.1
TURP组	32	12.5±7.6	6.8±4.7	5.8±3.2	13.2±6.5	45.0±57.6	3.2±1.8	2.3±1.4	0.9±1.2
P值	?	0.307	0.078	0.709	0.005	0.022	0.005	0.002	0.445

表4 良性前列腺增生症合并逼尿肌功能不全患者的两组术后排尿状态比较( ±s)

组别	例数	术后IPSS评分(分)	排尿症状评分(分)	储尿症状评分(分)	最大尿流量(ml / s)	术后残余尿量(ml)	总IPSS评分^Δ(分)	排尿症状评分^Δ(分)	储尿症状评分^Δ(分)
HoLEP组	24	10.7±5.4	4.7±3.7	6.1±3.5	18.5±7.1	13.75±41.7	8.0±7.4	6.5±5.8	1.5±3.1
TURP组	32	12.5±7.6	6.8±4.7	5.8±3.2	13.2±6.5	45.0±57.6	3.2±1.8	2.3±1.4	0.9±1.2
P值	?	0.307	0.078	0.709	0.005	0.022	0.005	0.002	0.445

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Comparison of surgical outcomes between holmium laser enucleation and classical transurethral resection of the prostate in patients with detrusor underactivity

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Comparison of surgical outcomes between holmium laser enucleation and classical transurethral resection of the prostate in patients with detrusor underactivity