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目的评估经尿道160 W高功率直出绿激光推铲式剜切术治疗大体积良性前列腺增生症(BPH)(体积>80 ml)的临床疗效及安全性。方法大体积BPH共212例,分别采用高功率直出绿激光推铲式剜切术治疗(PVRP-ST组,n=108例)和经尿道电切术治疗(TURP组,n=104例)。比较两组患者的手术时间、手术前后血红蛋白及血清Na~+变化、术后膀胱冲洗时间、术后留置尿管时间、术后住院时间,术前及术后3个月的国际前列腺症状评分(IPSS)、生活质量评分(QoL)、最大尿流率(Qmax)、膀胱残余尿量(PVR)等观察指标,并且记录术中及术后的手术并发症情况。结果两组共212例患者手术均一次顺利完成。PVRP-ST组与TURP组的平均手术时间分别为(66.1±18.2)min和(70.6±15.2)min,两组比较差异无统计学意义(P>0.05);两组手术前后平均血红蛋白浓度减少分别为(3.2±1.4)g/L和(14.7±5.6)g/L,平均血清Na~+减少分别为(1.78±0.81)mmol/L和(4.24±1.22)mmol/L,术后平均膀胱冲洗时间分别为(25.2±11.5)h和(64.4±18.5)h,术后平均留置尿管时间为(38.9±13.6)h和(82.7±15.4)h,平均术后住院时间(3.3±0.6)天和(7.4±1.2)天,两组相比较,差异有统计学意义(P<0.05)。术后3个月复查,两组患者IPSS、QoL、Qmax、PVR均较术前显著改善(P<0.05),术后改善情况两组间比较差异无统计学意义(P>0.05)。术中、术后并发症方面,PVRP-ST组术后出现轻微排尿不适34例,肉眼血尿8例,逆行射精5例,一过性尿失禁3例,无尿潴留、尿道狭窄等情况的发生;TURP组术后出现轻度排尿不适48例,肉眼血尿15例,一过性尿失禁8例,逆行射精12例,无尿道狭窄,两组间比较,差异有统计学意义(P<0.05)。结论160 W高功率直出绿激光推铲式剜切术治疗大体积BPH是一种安全有效的微创治疗方法,与TURP相比较,具有术中出血更少,术后恢复更快,安全性更高等优点,尤其适用于高危、高龄的大体积前列腺增生BPH患者。
Objective To evaluate the clinical efficacy and safety of transurethral 160 W high power straight green laser shovel lobectomy in the treatment of massive benign prostatic hyperplasia (BPH) (volume> 80 ml). Methods A total of 212 cases of large volume BPH were treated with high-powered straight-out green laser shovel shunt (n = 108 in PVRP-ST group) and transurethral resection (n = 104 in TURP group) . The operation time, changes of hemoglobin and serum Na ~ + before and after operation, postoperative bladder irrigation time, postoperative indwelling catheter time, postoperative hospital stay, preoperative and postoperative 3 months international prostate symptom score IPSS, QoL, Qmax and residual bladder volume (PVR) were recorded. The intraoperative and postoperative complications were recorded. Results A total of 212 patients in both groups were successfully completed the operation. The mean operation time of PVRP-ST group and TURP group was (66.1 ± 18.2) min and (70.6 ± 15.2) min respectively, with no significant difference between the two groups (P> 0.05). The mean hemoglobin concentration decreased The mean serum Na ~ + levels were (3.2 ± 1.4) g / L and (14.7 ± 5.6) g / L, respectively, and the mean serum Na ~ + decrease was (1.78 ± 0.81) mmol / L and (25.2 ± 11.5) h and (64.4 ± 18.5) h respectively. The mean postoperative urinary catheterization time was (38.9 ± 13.6) h and (82.7 ± 15.4) h, respectively. The average postoperative hospital stay was (3.3 ± 0.6) days And (7.4 ± 1.2) days, respectively. There was significant difference between the two groups (P <0.05). Three months after the operation, IPSS, QoL, Qmax and PVR in both groups were significantly improved compared with that before operation (P <0.05). There was no significant difference between the two groups in postoperative improvement (P> 0.05). There were 34 cases of minor urination discomfort, 8 cases of gross hematuria, 5 cases of retrograde ejaculation, 3 cases of transient urinary incontinence, no urinary retention and urethral stricture in PVRP-ST group during operation and postoperative complications There were 48 cases of slight urination discomfort, 15 cases of gross hematuria, 8 cases of transient urinary incontinence, 12 cases of retrograde ejaculation, no urethral stricture in the TURP group. The difference was statistically significant (P <0.05) . Conclusion The 160 W high-power, straight-green laser shovel lobectomy for the treatment of large-volume BPH is a safe and effective minimally invasive treatment. Compared with TURP, it has the advantages of less intraoperative bleeding, faster postoperative recovery, and safety More advantages, especially for high-risk, elderly BPH patients with large-volume benign prostatic hyperplasia.