450 nm蓝激光解剖性汽化术治疗老年衰弱大体积前列腺增生的前瞻性队列研究

A prospective cohort study of 450 nm blue laser anatomical vaporization of the prostate for elderly frail patients with large-volume benign prostatic hyperplasia

摘要

目的 探讨450 nm蓝激光解剖性汽化术（ABVP）治疗老年衰弱大体积良性前列腺增生（BPH）患者的安全性和有效性。方法 采用前瞻性队列研究设计，纳入2024年1月-2025年10月在北京老年医院泌尿外科拟行前列腺切除术的60例老年衰弱大体积BPH患者作为研究对象。根据手术方式分为ABVP组和经尿道等离子前列腺剜除（PKEP）组，每组30例。比较两组患者术前及术后1、3、6个月国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、残余尿量（PVR）及生活质量评分（QoL）以及围手术期指标和术后并发症。结果 术后1、3、6个月随访，两组患者的IPSS、Qmax、PVR、QoL均较术前显著改善（P＜0.05），但组间比较差异无统计学意义（P＞0.05）。与PKEP组比较，ABVP组的手术时间更短[（63.60±11.22）min对比（58.13±8.86）min，P=0.04]、术后24 h血红蛋白下降量更低[（14.38±12.44）g/L对比（7.01±17.09）g/L，P=0.006]，膀胱冲洗时间更短[（52.40±14.94）h对比（24.80±9.93）h，P＜0.001]、尿管留置时间更短[（4.97±0.67）d对比（3.73±0.91）d，P＜0.001）]、住院时间更短[（6.03±0.67）d对比（4.33±0.84）d，P＜0.001）]。ABVP组与PKEP组的总并发症发生率比较，差异有统计学意义（13.3%对比40.0%，P=0.04）。结论 对于老年衰弱大体积BPH患者的治疗，ABVP与PKEP改善BPH引起的下尿路症状疗效相当，但在止血及术后恢复方面ABVP优于PKEP，是该特殊人群的优选手术方案之一。

Abstract

Objective To investigate the safety and efficacy of 450 nm anatomical blue laser vaporization of the prostate (ABVP) in the treatment of elderly frail patients with large-volume benign prostatic hyperplasia (BPH). Methods A prospective cohort study design was adopted. A total of 60 elderly frail patients with large-volume BPH who underwent prostatectomy in our hospital during Jan. 2024 and Oct. 2025 were enrolled. According to the surgical approaches, the patients were divided into the ABVP group (n=30) and the transurethral plasmakinetic enucleation of the prostate group (PKEP group, n=30). Preoperative and postoperative (1, 3, and 6 months) international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), post-void residual (PVR), and quality of life score (QoL) were compared between the two groups, along with perioperative parameters and postoperative complications. Results At 1, 3, and 6 months postoperatively, both groups showed significant improvement in IPSS, Qmax, PVR and QoL compared with preoperative values (P<0.05), with no statistically significant differences between groups (P>0.05). Compared with the PKEP group, the ABVP group demonstrated significantly shorter operation time [(63.60±11.22) min vs. (58.13±8.86) min, P=0.04], less postoperative hemoglobin decline [(14.38±12.44) g/L vs. (7.01±17.09) g/L, P=0.006], shorter bladder irrigation time [(52.40±14.94) h vs. (24.80±9.93) h, P<0.001], shorter catheterization duration [(4.97±0.67) d vs. (3.73±0.91) d, P<0.001], and shorter hospital stay [(6.03±0.67) d vs. (4.33±0.84) d, P<0.001]. The overall complication rate was 13.3% in the ABVP group and 40.0% in the PKEP group, with statistically significant difference (P=0.04). Conclusion ABVP is comparable to PKEP in improving BPH-induced lower urinary tract symptoms, yet superior in hemostasis and postoperative recovery, serving as one of the surgical options for this specific cohort of patients.

关键词

良性前列腺增生 / 蓝激光 / 前列腺解剖性汽化切除术 / 老年衰弱

Key words

benign prostatic hyperplasia / blue laser / anatomical vaporization of the prostate / elderly frailty

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基金资助

北京老年医院启航项目(2023bjlnyy-qh-1)