目的 比较经尿道前列腺铥激光剜除术(Thulium laser enucleation of prostate,ThuLEP)与钬激光前列腺剜除术(Holmium laser enucleation of prostate,HoLEP)的临床疗效.方法 回顾性分析2020年9月至2022年12月,合并膀胱出口梗阻(bladder outlet obstruction,BOO)的良性前列腺增生症(benign prostatic hyperplasia,BPH)患者292例,按照治疗方法不同分为HoLEP组和ThuLEP组,HoLEP组患者152例,采用HoLEP治疗,治疗功率80~100 W,能量2.5 J,频率40 Hz.ThuLEP组患者140例,采用ThuLEP治疗,治疗功率80 W,能量2.0 J,频率40 Hz.术后3个月,比较两组患者切除前列腺质量;围手术期相关指标包括手术时间、平均住院时间、拔管平均时间、术后1 d血红蛋白、血钠改变.术后3个月,比较国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life score,QOL)、最大尿流率(maximum urinary flow rate,Qmax)、残余尿量改变.同时,观察两组治疗期间并发症发生情况.结果 两组手术均顺利完成,HoLEP组和ThuLEP组手术平均时间分别为(68±22)min,(73±18)min,两组比较差异无统计学意义(P>0.05). HoLEP组和ThuLEP组切除前列腺质量分别为(79±18)g、(70±17)g,两组比较差异具有统计学意义(P<0.05).与术前比较,HoLEP组和ThuLEP组术后1 d血红蛋白降低分别下降了(1.05±0.4)g、(1.5±0.4)g,血钠分别下降了(4.3±1.4)mmol/L、(3.9±1.2)mmol/L;术后HoLEP组和ThuLEP组平均住院时间分别为(52±3)h、(44±12)h,两组比较差异具有统计学意义(P<0.05).HoLEP组和ThuLEP组拔管平均时间分别为(31±5)h,(23±4)h,两组比较差异具有统计学意义(P<0.05).随访3个月以上,两组术后3个月,IPSS、QOL、Qmax、残余尿量与术前比较均明显改善(P<0.05),两组间比较差异无统计学意义(P>0.05).结论 HoLEP与ThuLEP治疗前列腺增生症短期疗效相当,均具有出血少、恢复快、残留腺体少、并发症少等优点.
Comparison of Therapeutic Effect of Holmium Laser and Thulium Laser Enucleation for Benign Prostatic Hyperplasia:A Report Based on 292 Cases from A Medical Institution
Objective To compare the outcomes of transurethral resection of benign prostatic hyperplasia(BPH)with Holmium laser enucleation of prostate(HoLEP)and Thulium laser enucleation of prostate(ThuLEP).Methods A retrospective analysis was conducted on 292 patients of benign prostatic hyperplasia(BPH)complicated with bladder outlet obstruction(BOO)and treated over the period from Sep.2020 to Dec.2022.They were divided into two groups by treating methods:the HoLEP group(n=152)and ThuLEP group(n=140).The treating power,energy and frequency used for the HoLEP group were 80 W~100 W,2.5 J and 40 Hz respectively,and those for the ThuLEP group were 80 W,2.0 J and 40 Hz respectively.The quality of prostate resection was compared between the patients of the two groups.The perioperative indicators used in the study included surgical time,average hospital stay,average extubation time and changes to hemoglobin and blood sodium 1 day after the surgery.The follow-up lasted for 3 months.The changes to the International Prostate Symptom Score(IPSS),Quality of Life Score(QOL),Maximum Urinary Flow Rate(Qmax)and residual urinary volume 3 months after the surgery were observed.Results The surgery was conducted successfully for each patient of the two groups with an average surgical time of(68±22)minutes in the HoLEP group and(73±18)minutes in the ThuLEP group respectively.There was no statistically significant difference between the two groups(P>0.05).The mass of prostate resection in the HoLEP group and ThuLEP group were(79±18)g and(70±17)g respectively,and the difference between two groups was statistically significant(P<0.05).The HoLEP group and ThuLEP group showed a decrease in hemoglobin with(1.05±0.4)g and(1.5±0.4)g,and a decrease in blood sodium with(4.3±1.4)mmol/L and(3.9±1.2)mmol/L,1 day after the surgery.The average hospitalization time for the postoperative HoLEP group and ThuLEP group were(52±3)hours and(44±12)hours respectively,and the difference was statistically significant(P<0.05).The average extubation time for the HoLEP group and the ThuLEP group were(31±5)hours and(23±4)hours respectively,and the difference was statistically significant(P<0.05).It was revealed via 3 months'follow-up that the International Prostate Symptom Score(IPSS),Quality of Life Score(QOL),Maximum Urinary Flow Rate(Qmax)and residual urine volume of both groups were significantly improved 3 months after the surgery(P<0.05).There was no statistically significant difference between the two groups(P>0.05).Conclusions HoLEP and ThuLEP have a similar short-term efficacy in the treatment of BPH.