“露天隧道法”经尿道前列腺超脉冲光纤铥激光剜除术与钬激光剜除术治疗良性前列腺增生的临床效果比较

Comparison of the clinical efficacy of super pulse thulium laser enucleation of the prostate with “open tunnel” and holmium laser enucleation of the prostate for benign prostatic hyperplasia

摘要

目的 对比“露天隧道法”经尿道前列腺超脉冲光纤铥激光剜除术（SPThuLEP）与经尿道前列腺钬激光剜除术（HoLEP）治疗良性前列腺增生（BPH）的临床效果，以期为 BPH 治疗方案的选择提供参考。方法 回顾性分析 2023 年 1-7 月于上海市浦东新区公利医院接受经尿道激光手术治疗的 112 例 BPH 患者的临床资料，其中 65 例采用“露天隧道法”SPThuLEP 治疗（SPThuLEP 组），57 例采用 HoLEP 治疗（HoLEP 组）。比较两组患者的手术时间、术后血红蛋白下降量、术后膀胱冲洗时间、留置导尿管时间、住院时间及并发症发生情况。比较两组患者术前及术后 1 个月最大尿流率（Qmax）、国际前列腺症状评分（IPSS）、生活质量评分（QoL）、膀胱残余尿量（PVR）、前列腺特异性抗原（PSA）水平。结果 所有患者均顺利完成手术，无中转开放或经尿道等离子电切术。SPThuLEP 组患者术后血红蛋白下降量低于 HoLEP 组[（13.12±6.72）g/L vs.（21.02±6.51）g/L]，差异有统计学意义（P＜0.05）。SPThuLEP 组和 HoLEP 组患者的平均手术时间[（63.35±15.73）min vs.（61.02±17.55）min]、术后膀胱冲洗时间[（1.07±0.45）d vs.（1.06±0.36）d]、留置导尿管时间[（2.98±0.56）d vs.（3.01±0.63）d]及住院时间[（3.63±0.61）d vs.（3.79±0.76）d]比较，差异均无统计学意义（P＞0.05）。所有患者均未输血，均无二次出血、非计划二次住院、电切综合征（TURS）、尿道狭窄、尿失禁等严重并发症。术后 1 个月两组患者的 Qmax、IPSS、QoL、PVR 及 PSA 水平均较术前明显改善（P＜0.05），但两组间上述指标差异均无统计学意义（P＞0.05）。结论 采用“露天隧道法”SPThuLEP 治疗 BPH 的临床疗效与 HoLEP 相当，但该微创手术的术中及术后出血量更少且安全性高，值得在临床广泛推广。

Abstract

Objective To compare the clinical efficacy of super pulse thulium laser enucleation of the prostate (SPThuLEP) with “open tunnel” and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH), in order to provide reference for the treatment options of BPH. Methods The clinical data of 112 BPH patients treated in our hospital during Jan. 2023 and Jul. 2023 were retrospectively analyzed, including 65 treated with SPThuLEP with “open tunnel” and 57 with HoLEP. The operation time, postoperative hemoglobin decrease, postoperative bladder irrigation, catheter indwelling time, hospitalization time and complications were compared between the two groups. The changes of maximum urine flow rate (Qmax), international prostate symptom score (IPSS), quality of life score (QoL), postvoid residual (PVR) and prostate-specific antigen (PSA) were compared between the two groups before operation and one month after operation. Results All operations were successful without conversion to open or transurethral plasma kinetic resection. The postoperative decrease of hemoglobin in SPThuLEP group was lower than that in HoLEP group [(13.12±6.72) g/L vs. (21.02±6.51) g/L], with statistical difference (P<0.05). There were no significant differences in the operation time [(63.35±15.73) min vs. (61.02±17.55) min], postoperative bladder irrigation time [(1.07±0.45) d vs. (1.06±0.36) d], catheter indwelling time [(2.98±0.56) d vs. (3.01±0.63) d] and hospitalization time [(3.63±0.61) d vs. (3.79±0.76) d] between the two groups (P>0.05). No blood transfusion, secondary bleeding or unplanned hospitalization occurred, and there were no serious complications such as transurethral electroresection syndrome (TURS), urethral stricture and urinary incontinence. One month after operation, the Qmax, IPSS, QoL, PVR and PSA of the two groups were significantly improved compared with those before operation (P<0.05), but with no statistical difference between the two groups (P>0.05). Conclusion SPThuLEP with “open tunnel” has comparable efficacy as HoLEP in the treatment of BPH. With advantages of small amount of bleeding and high safety, this minimally invasive technique can be widely popularized in clinical practice.

关键词

超脉冲光纤铥激光 / 钬激光 / 良性前列腺增生 / 剜除术 / “露天隧道法”

Key words

super pulse thulium laser / holmium laser / benign prostatic hyperplasia / enucleation of the prostate / “open tunnel method”

参考文献

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基金资助

浦东新区卫生系统医学学科建设项目(PWYgf2021-06)

浦东新区中医药传承创新发展展示试点项目浦东新区中西医协同旗舰科室建设计划资助项目(YC-2023-0405)

浦东新区卫生健康委员会卫生科研计划项目(PW2023A-41)