2μm激光汽化切除术与等离子双极电切术治疗良性前列腺增生的疗效比较

摘要

目的 比较2μm激光汽化切除术与等离子双极电切术(TUPKP)治疗良性前列腺增生(BPH)的疗效和安全性.方法 随机采用2μm激光汽化切除术与TUPKP两种手术方式治疗BPH患者176例,其中2μm激光组90例,TUPKP组86例.监测、记录两组患者术前、术中及术后的相关临床指标,进行对比、分析.结果 术前两组一般情况比较差异无显著性(P>0.05).2μm激光组手术时间(80.2±16.9)min大于TUPKP组(69.5±17.8)min,两组间比较差异有显著性(P<0.01)；2μm激光组术中冲洗液量(21.4±4.1)L、术中出血量(50.4±13.0)mL、术后膀胱冲洗时间(15.5±7.5)h、留置尿管时间(2.4±0.3)d、术后住院时间(5.0±0.7)d均小于TUPKP组[术中冲洗液量(27.1±4.2)L、术中出血量(87.5±20.4)mL、术后膀胱冲洗时间(46.4±9.4)h、留置尿管时间(4.4±0.8)d、术后住院时间(7.1±0.7)d],两组间比较差异有显著性(P<0.01).术后随访3个月,两组患者国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Q<,max>)及残余尿量(PVR)较术前均明显改善(P<0.01),但两组之间比较差别无显著性(P>0.05).两组术后并发症的发病率比较差异无显著性(P>0.05).结论 2μm激光汽化切除术能明显改善患者的下尿路症状,具有与TUPKP相同的近期疗效；较TUPKP具有操作简单、出血少、术后留置尿管时间及住院时间短、恢复快等优点,是一种治疗BPH安全、有效的微创手术方式.%[ Objective ] To compare the therapeutic effects of the two micron laser vaporesection of prostate and bipolar transurethral plasmakinetic prostatectomy (TUPKP) for the treatment of benign prostatic hyperplasia (BPH). [Methods] One hundred and seventy-six cases of BPH were divided into two groups randomly, ninety cases of them underwent two micron laser vaporization resection and eighty-six cases for TUPKP. The significant markers and ther-apeutic results were recorded and analyzed. [Results] There was no significant difference between the two groups in some preoperative factors (P >0.05). The time of operation for TUPKP was (69.5+17.8) min, shorter than that for two micron laser vaporesection, (80.2±16.9) min. The volume of irrigating fluid during operation for two micron laser va-poresection was (21.4±4.1) L, less than that for TUPKP, (27.1±4.2) L. The blood loss in operation for two micron laser vaporesection was (50.4±13.0) mL, less than that for TUPKP, (87.5±20.4) mL. The time of bladder irrigating after operation was (15.5±7.5) h in two micron laser group, shorter than the (46.4±9.4) h in TUPKP group. The time of catheterization was (2.4±0.3) d in two micron laser group, shorter than the (4.4±0.8) d in TUPKP group. Hospital stay after surgical therapy was (5.0±0.7) d in two micron laser group, shorter than the (7.1 ±0.7) d in TUPKP group. Significant difference was found between the two groups in the above six markers (P <0.05). All the cases were followed up for 3 months, IPSS, QOL, Qmax and PVR were improved significantly compared with that of preoperative in both groups (P <0.01), but no significant difference had been noted with different procedure (P >0.05). There was no significant difference between the two groups in operative complications (P>0.05). [Conclusions] The two micron laser ' vaporesection of prostate can significantly improve the patients' lower urinary tract symptoms, and has the same early efficacy as well as TUPKP. Compared to TUPKP, two micron laser vaporesection of prostate has more advantages of simpler operation, less blood loss, shorter postoperative catheter indwelling time and hospital stay, rapid recovery after surgery. Two micron laser vaporesection of the prostate is a safe and effective minimally invasive treatment for BPH.