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目的比较经尿道2μm铥激光前列腺剜除术(TmLEP)、经尿道前列腺等离子剜除术(PKEP)及经尿道前列腺等离子切除术(PKRP)3种术式治疗高危重度前列腺增生的安全性和有效性。方法回顾性分析2014年1月至2016年1月在我院行手术治疗BPH的。患者152例,其中TmLEP组35例,PKEP组53例,PKRP组64例。对比各组手术患者手术时间、术中出血量、腺体切除量、术后并发症及疗效等。结果 TmLEP组、PKEP组和PKRP组手术时间分别为(64.3±15.9)min、(63.2±15.4)min和(80.1±24.3)min,TmLEP组及PKEP组较PKRP组手术时间明显短,差异具有统计学意义(P<0.05)。出血量TmLEP组、PKEP组和PKRP组分别为(26.3±6.2)mL、(27.4±6.1)m L和(60.4±10.2)mL,TmLEP组及PKEP组较PKRP组出血量明显少,差异具有统计学意义(P<0.05)。TmLEP组、PKEP组、PKRP组切除腺体质量分别为(50.9±6.6)g、(52.8±8.3)g和(32.9±6.3)g,TmLEP组及PKEP组较PKRP组切除腺体明显多,差异具有统计学意义(P<0.05)。术中TmLEP组、PKEP组、PKRP组出现包膜穿孔的例数分别为1例(2.9%)、1例(1.9%)和8例(12.5%)。PKEP组较PKRP组包膜穿孔率明显少,差异有统计学意义(P<0.05)。TmLEP组、PKEP组和PKRP组出现暂时性尿失禁的病例数分别为2例(5.7%)、2例(3.8%)、10例(15.6%)。PKEP组暂时性尿失禁发生率明显小于PKRP组,差异具有统计学意义(P<0.05)。术后1个月、6个月随访最大尿流率(Q_(max))、残余尿量(RUV)、国际前列腺症状评分(IPSS)、生活质量评分(QoL)等各项指标较术前均有较大改善,差异有统计学差异(P<0.05)。各组组内术后1个月与6个月之间差异无统计学意义(P>0.05)。各组组间术后1个月、术后6个月的各项指标在对应时间点比较也无统计学差异(P>0.05)。结论 TmLEP、PKEP及PKRP 3种术式均能有效缓解高危重度BPH的症状,但TmLEP及PKEP较PKRP手术时间短、术中出血少、腺体切除多、并发症少。加强围手术期的处理和个体化手术方案的选择是手术治疗高危重度BPH的关键。
Objective To compare the safety and efficacy of transurethral 2 μm 铥 laser prostatectomy (TmLEP), transurethral prostatectomy (PKEP) and transurethral resection of the prostate (PKRP) for the treatment of high-risk severe prostatic hyperplasia . Methods A retrospective analysis of surgical treatment of BPH in our hospital from January 2014 to January 2016 was performed. 152 patients, including TmLEP group 35 cases, PKEP group 53 cases, PKRP group 64 cases. The operation time, intraoperative blood loss, gland resection volume, postoperative complications and curative effect were compared between the two groups. Results The operation time of TmLEP group, PKEP group and PKRP group were (64.3 ± 15.9) min and (63.2 ± 15.4) min and (80.1 ± 24.3) min, respectively. The operation time of TmLEP group and PKEP group was significantly shorter than that of PKRP group Significance (P <0.05). The amount of bleeding in TmLEP group, PKEP group and PKRP group were (26.3 ± 6.2) mL and (27.4 ± 6.1) m L and (60.4 ± 10.2) mL, respectively. TmLEP group and PKEP group had less blood loss than PKRP group Significance (P <0.05). The numbers of resected glands in TmLEP group, PKEP group and PKRP group were (50.9 ± 6.6) g, (52.8 ± 8.3) g and (32.9 ± 6.3) g, respectively. The numbers of resected glands in TmLEP group and PKEP group were significantly higher than those in PKRP group Statistically significant (P <0.05). There were 1 case (2.9%), 1 case (1.9%) and 8 cases (12.5%) of the cases with perforation in the TmLEP group, PKEP group and PKRP group. Compared with PKRP group, the perforation rate of capsular membrane in PKEP group was significantly less, the difference was statistically significant (P <0.05). The number of patients with temporary urinary incontinence in the TmLEP, PKEP and PKRP groups was 2 (5.7%), 2 (3.8%) and 10 (15.6%) respectively. The incidence of temporary urinary incontinence in PKEP group was significantly lower than that in PKRP group, the difference was statistically significant (P <0.05). The indexes of Qmax, RUV, IPSS and QoL at 1 month and 6 months after operation were significantly lower than those before operation There was a significant improvement, the difference was statistically significant (P <0.05). There was no significant difference between one month and six months after operation in each group (P> 0.05). There was no significant difference in each index between 1 month postoperatively and 6 months postoperatively at corresponding time points (P> 0.05). Conclusion TmLEP, PKEP and PKRP can effectively relieve the symptoms of high-risk severe BPH. TmLEP and PKEP have shorter operation time, less bleeding, fewer glands and fewer complications than PKRP. To strengthen the perioperative management and individualized surgical options is the key to surgical treatment of high-risk severe BPH.