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高低功率钬激光剜除治疗不同体积良性前列腺增生的疗效分析

Efficacy analysis of high and low-power holmium laser enucleation in the treatment of benign prostatic hyperplasia with different volumes

    摘要
  • 摘要:
    目的 探讨高功率与低功率钬激光剜除术治疗不同体积良性前列腺增生（benign prostatic hyperplasia，BPH）的疗效，评估在不同体积BPH中，低功率钬激光替代高功率钬激光行前列腺剜除术的可行性。
    方法 选取2019年1月至2020年12月南通大学第二附属医院泌尿外科收治的163例BPH患者。根据前列腺体积大小分为中小体积（SMVG，30<V≤80 mL）组（n=90）和大体积（LVG，V>80 mL）组（n=73）。再将各组患者随机分为低功率（45 W）前列腺钬激光剜除组（low power-holmium laser enucleation of prostate，LP-HoLEP）和高功率（80 W）前列腺钬激光剜除组（HP-HoLEP），收集并比较各组的人口统计学、围手术期指标、术后并发症等资料，术后随访时间为6个月。
    结果 在SMVG组，LP-HoLEP与HP-HoLEP在围手术期指标及术后并发症差异无统计学意义；在LVG组，LP-HoLEP与HP-HoLEP在粉碎时间、及术后并发症差异无统计学意义，而LP-HoLEP的手术时间（103.43 min vs 86.74 min，P < 0.001）及剜除时间（83.53 min vs 65.30 min，P < 0.001）更长、剜除前列腺质量更少（65.30 mg vs 68.88 mg，P=0.02）、剜除效率更低（0.78 g/min vs 1.05 g/min，P < 0.001）、术后的住院时间（4.33 d vs 3.68 d，P < 0.001）及尿管留置时间（4.10 d vs 3.20 d，P < 0.001）更长、血红蛋白（Hb）下降更少（8.78 g/L vs 9.85 g/L，P=0.02）更少。术后1个月、6个月随访各组的术前国际前列腺症状评分（IPSS）、术前残余尿（preoperative residual urine，PVR）均低于术前，Qmax均高于术前，差异均有统计学意义（P < 0.05）。
    结论 LP-HoLEP与HP-HoLEP治疗中小体积BPH的疗效基本相当，而对于大体积BPH，HP-HoLEP的剜除效率更高。

     

    Abstract:
    Objective To explore the efficacy of high and low-power holmium laser enucleation in the treatment of benign prostatic hyperplasia (BPH) with different volumes, and to evaluate the feasibility of low-power holmium laser instead of high-power holmium laser for prostate enucleation in different volumes of BPH.
    Methods A total of 163 patients with BPH who were admitted to the Department of Urology, The second Affiliated Hospital of Nantong University from January 2019 to December 2020 were selected. According to the size of the prostate, patients was divided into small and medium volume group (SMVG, 30<V ≤ 80 mL, n=90) and large volume group (LVG, V>80 mL, n=73), and the patients in each group were randomly divided into low power-holmium laser enucleation of the prostate (LP-HoLEP, 45 W) and high-power holmium laser enucleation of the prostate (HP-HoLEP, 80 W). The demographics, perioperative indicators, and postoperative complications of each group were collected and compared, and the postoperative follow-up was 6 months.
    Results In SMVG, there was no statistically significant difference between LP-HoLEP and HP-HoLEP in the perioperative indicators and postoperative complications. In LVG, LP-HoLEP and HP-HoLEP had no statistically significant difference in comminuted time and postoperative complications, while in LP-HoLEP, the operation time (103.43 min vs 86.74 min, P < 0.001) and enucleation time (83.53 min vs 65.30 min, P < 0.001) was longer, the quality of enucleation of the prostate (65.30 mg vs 68.88 mg, P=0.02) was less, the enucleation efficiency (0.78 g/min vs 1.05 g/min, P < 0.001) was lower, postoperative hospital stay (4.33 d vs 3.68 d, P < 0.001) and catheter indwelling time (4.10 vs 3.20 d, P < 0.001) were longer, and HB reduction value (8.78 g/L vs 9.85 g/L, P=0.02) was less. The IPSS and PVR of each group in the follow-up at 1 and 6 months after operation were lower than those before the operation, and Qmax was higher than before the operation, and the difference was statistically significant (P < 0.05).
    Conclusions LP-HoLEP and HP-HoLEP have the same curative effect in the treatment of small and medium volume BPH, and for large volume BPH, HP-HoLEP has a higher enucleation efficiency.

     

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