摘要
目的 观察低功率(60W)经尿道前列腺钬激光剜除术(HoLEP)与经尿道等离子前列腺剜除术(TUPKEP)在老年原发性良性前列腺增生治疗中的近期疗效.方法 回顾性选取2016年3月至2022年12月在太原钢铁(集团)有限公司总医院106例老年原发性良性前列腺增生患者作为研究对象,按照治疗方法不同分为两组,每组各53例.观察组患者采用低功率HoLEP治疗,对照组患者采用TUPKEP治疗.比较两组手术相关指标(手术时间、出血量、膀胱冲洗时间、留置导尿管时间、住院时间),比较两组手术前后尿动力参数[最大尿流率(Qmax)、平均尿流率(Qave)、残余尿量(RUV)、有效膀胱容积(ECBC)]、生活质量(QOL)评分、国际勃起功能问卷-5(IIEF-5)评分、国际前列腺症状(IP-SS)评分差异,并比较两组术后性功能情况和并发症发生情况.结果 观察组的手术时间、膀胱冲洗时间、留置导尿管时间、住院时间分别为(77.06±8.56)min、(34.77±8.05)h、(48.05±6.96)h、(4.51±1.74)d,均短于对照组[(85.41±12.23)min、(47.45±9.63)h、(57.44±11.63)h、(6.55±2.41)d],出血量为(46.12±10.03)mL,少于对照组[(65.85±12.98)mL],差异均有统计学意义(P＜0.05);两组的术中输液量和前列腺切除量比较,差异均无统计学意义(P＞0.05).观察组术后 6 个月 Qmax、Qave、ECBC 分别为(21.74±3.03)mL/s、(10.45±2.36)mL/s、(224.74±15.78)mL,均高于对照组[(17.86±2.86)mL/s、(8.47±2.11)mL/s、(197.85±12.66)mL],RUV 为(13.36±5.44)mL,低于对照组[(25.86±8.05)mL],差异均有统计学意义(P＜0.05).观察组术后6个月IIEF-5评分为(21.96±3.01)分,高于对照组[(20.18±2.97)分],IPSS评分、QOL评分分别为(6.01±0.87)、(9.14±1.23)分,均低于对照组[(9.14±1.23)、(1.57±0.23)分],差异均有统计学意义(P＜0.05).观察组IIEF-5评分≤7分、逆行性射精发生率及并发症发生率与对照组比较,差异均无统计学意义(P＞0.05).结论 低功率HoLEP治疗老年原发性良性前列腺增生的近期疗效优于TUPKEP,术后恢复较快,可改善尿动力参数,减轻症状,提高生活质量.
Abstract
Objective To observe the short-term efficacy of low power(60W)transurethral holmium laser enucleation of prostate(Ho-LEP)and transurethral plasmakinetic enucleation of prostate(TUPKEP)in the treatment of elderly patients with primary benign prostatic hyper-plasia.Methods A total of 106 elderly patients with primary benign prostatic hyperplasia in the General Hospital of Taiyuan Iron and Steel(Group)Co.,LTD.from March 2016 to December 2022 were retrospectively selected as the research objects.They were divided into two groups according to different treatment methods,with 53 cases in each group.The observation group was treated with low power HoLEP,and the control group was treated with TUPKEP.The operation related indexes(operation time,bleeding volume,bladder irrigation time,indwelling catheter time and hospitalization time)were compared between the two groups.The urodynamic parameters[maximum urinary flow rate(Qmax),mean urinary flow rate(Qave),residual urine volume(RUV),effective bladder volume(ECBC)],quality of life(QOL)score,international index of erectile function-5(IIEF-5)score and international prostate symptom score(IPSS)were compared between the two groups before and after operation,and the postoperative sexual function and complications were compared between the two groups.Results The operation time,bladder irrigation time,indwelling catheter time and hospitalization time of the observation group were(77.06±8.56)min,(34.77±8.05)h,(48.05±6.96)h and(4.51±1.74)d,respectively,which were shorter than those of the control group[(85.41±12.23)min,(47.45±9.63)h,(57.44±11.63)h,(6.55±2.41)d],and the amount of bleeding was(46.12±10.03)mL,which was less than that of the control group[(65.85±12.98)mL],the differences were statistically significant(P＜0.05);there were no statistically significant differences in intraoperative infu-sion volume and prostatectomy volume between the two groups(P＞0.05).The Qmax,Qave and ECBC of the observation group at 6 months after operation were(21.74±3.03)mL/s,(10.45±2.36)mL/s and(224.74±15.78)mL,respectively,which were higher than those of the con-trol group[(17.86±2.86)mL/s,(8.47±2.11)mL/s,(197.85±12.66)mL],and the RUV was(13.36±5.44)mL,which was lower than that of the control group[(25.86±8.05)mL],the differences were statistically significant(P＜0.05).The IIEF-5 score of the obser-vation group at 6 months after operation was(21.96±3.01)points,which was higher than that of the control group[(20.18±2.97)points],the IPSS score and QOL score were(6.01±0.87)and(9.14±1.23)points,respectively,which were lower than those of the control group[(9.14±1.23),(1.57±0.23)points],and the differences were statistically significant(P＜0.05).There were no statistically significant differences in IIEF-5 score ≤7 points,the incidence of retrograde ejaculation and complications between the two groups(P＞0.05).Conclu-sion Low power HoLEP can improve urinary dynamic parameters,alleviate symptoms and improve quality of life in elderly patients with primary benign prostatic hyperplasia.
基金项目
山西省重点研发计划项目(201803D31103)
维普
万方数据