经尿道前列腺钬激光剜除术和前列腺电切术的疗效比较

摘要

Objective :To compare the safety and efficacy between holmium laser enucleation of the prostate(HOLEP) and transurethral resection of prostate(TURP)for treatment to benign prostate hyperplasia .Methods :Total 60 BPH pa‐tients with indication for surgery were assigned to receive HOLEP or TURP ,with 30 cases in each group .Preoperative assessments included The International Prostate Symptom Score(IPSS) ,the maximum flow rate of urine(Qmax ) ,post ‐void residual urine volume(PVRU) ,ultrasound hemoglobin ,Perioperative assessments included total operating time ,re‐sected tissue weight ,hemoglobin loss ,presence or absence of blood transfusion ,time of catheter removal and duration of hospital stay .Postoperative evaluations were conducted at 1 ,3 ,6 and 12 months .Results :Patients in the HOLEP group had shorter catheterization time and hospital stay ,but longer operating time .Mean hemoglobin loss was lower in the HOLEP group .The follow‐up results up to 12 months regarding IPSS score ,PRV urine volume and Qmax showed that both groups were comparable .Complications were similar between the two procedures with no significant differ‐ence .Conclusion :HOLEP and TURP are safe and highly effective technique for treatment to BPH .But HOLEP more suitable bigger prostate .%目的：比较经尿道前列腺钬激光剜除术（Holmium laser enucleation of the prostate ，HOLEP）与经尿道前列腺电切术（Transurethral resection of prostate ，TURP）治疗良性前列腺增生（Benign prostate hyperplasia ，BPH）的安全性及疗效。方法：随机选取我院2012年3月－2013年9月良性前列腺增生症手术患者，行 HOLEP 患者30例，行 TURP患者30例，所选取患者术前均进行评估测定，测评项目包括国际前列腺症状评分（International prostate symptom score ，IPSS 评分）、最大尿流率（Qmax ）、残余尿量（Post‐void residual urine volume ，PVRU）、前列腺超声检查、前列腺特异抗原（PSA）、血红蛋白（HGB）含量。围术期测定项目包括总手术时间、切除前列腺组织的重量、血红蛋白下降值、有无输血、留置尿管时间、住院时间。并且术后患者在1、3、6、12个月时均随访评估。所选患者均有下尿路梗阻症状，保守治疗无明显效果，均有手术适应证。均已行微创腔镜手术治疗。比较两组术中、术后及随访时数据的变化，进行统计学分析。结果：两组患者年龄、术前 IPSS 评分、Qmax 、PVRU 、前列腺体积、血红蛋白水平差异无统计学意义（P＞0．05）。 HOLEP 组比 TURP 组留置尿管时间及住院时间短，术后血红蛋白下降值低，但 HOLEP 组手术时间长。两组手术并发症相似，差异无统计学意义。在术后12个月随访中，两组 IPSS 、Qmax 、PVRU 和术前相比，有明显改善。结论：HOLEP 与 TURP 都能够安全有效治疗 BPH ，而 HOLEP 更适于切除较大的前列腺。