[1]文爽,杨林,罗军,等.经尿道前列腺绿激光剜除术与前列腺电切术治疗前列腺增生症效果对比分析[J].第三军医大学学报,2020,42(18):1868-1875.
 WEN Shuang,YANG Lin,LUO Jun,et al.Comparison of therapeutic effects of green laser enucleation of the prostate and transurethral prostate resection for treatment of benign prostatic hyperplasia[J].J Third Mil Med Univ,2020,42(18):1868-1875.
点击复制

经尿道前列腺绿激光剜除术与前列腺电切术治疗前列腺增生症效果对比分析(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第18期
页码:
1868-1875
栏目:
临床医学
出版日期:
2020-09-30

文章信息/Info

Title:
Comparison of therapeutic effects of green laser enucleation of the prostate and transurethral prostate resection for treatment of benign prostatic hyperplasia
作者:
文爽杨林罗军熊波王洪志张成果王亚荣郑昌建
庆市璧山区人民医院泌尿外科
Author(s):
WEN Shuang YANG Lin LUO Jun XIONG Bo WANG Hongzhi ZHANG Chengguo WANG Yarong ZHENG Changjian

Department of Urology, Bishan People’s Hospital, Chongqing, 402760, China

关键词:
前列腺增生前列腺绿激光剜除术前列腺电切术
Keywords:
benign prostatic hyperplasia green laser enucleation of prostate transurethral prostate resection
分类号:
R697.32;R699.8
文献标志码:
A
摘要:

目的对比分析经尿道前列腺绿激光剜除术(green laser enucleation of prostate,GreenLEP)与经尿道前列腺电切术(transurethral resection of the prostate,TURP)治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)的效果。方法回顾性分析本院2017年2月至2018年11月收治的BPH患者104例,分别接受绿激光剜除术(GreenLEP组,52例)和电切术(TURP组,52例)治疗,评测两组患者手术时间、术中出血量、手术切除的前列腺体积以及术后膀胱冲洗时间、术后尿管留置时间、住院时间等相关指标,并比较手术前及手术后1、6个月的前列腺症状评分(IPSS)、生活质量(QoL)、最大尿流率(Qmax)、剩余尿量(PVR)、前列腺特异性抗原(PSA)、前列腺体积(PV)等指标。结果两组患者术后的Qmax、QoL、PVR、PSA、PV、IPSS和IIEF指标均较术前明显改善(P<0.001)。GreenLEP组的Qmax[(22.03±3.01) vs (19.08±2.62) mL/s, P<0.001]和IPSS评分[(5.35±1.67) vs (7.92±2.19), P<0.001]优于TURP组,但两组QoL、PVR、PSA、PV等差异无统计学意义。手术安全性比较:GreenLEP组在PV≤60 mL(较小体积)时术后膀胱冲洗时间优于TURP组[(18.88±2.36) vs (34.33±2.90 )h, P<0.001];GreenLEP组在前列腺中等体积(60 mL<PV<80 mL)时术中出血量[(63.30±4.27) vs (77.28±6.19 )mL,P<0.001] 、术后膀胱冲洗时间[(23.11±1.91) vs (41.56±3.15 )h,P<0.001]、术后住院时间[(3.07±0.61) vs (3.88±0.88)d,P<0.001]均优于TUPR组,而两组手术时间及前列腺切除体积差异无统计学意义;GreenLEP组在PV≥80 mL(较大体积)时,在所有监测指标上均优于TURP组(P<0.001)。GreenLEP组术后一过性尿失禁发生率高于TURP组,而GreenLEP术后低钠血症、性功能障碍、电切综合征发生率及术后输血率显著低于TURP组,差异均有统计学意义(P<0.05)。结论GreenLEP治疗BPH患者与TURP效果相当,在减少术中出血、术后膀胱冲洗时间、术后住院时间及降低术后并发症发生率上有明显优势,可能更加适合前列腺体积较大的患者。

Abstract:

ObjectiveTo evaluate the therapeutic effect of green laser enucleation of the prostate (GreenLEP) and transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH). MethodsFrom February, 2017 to November, 2018, 104 patients with BPH were treated with either GreenLEP (52 cases) or TURP (52 cases) in our hospital. The operation time, intraoperative bleeding volume, resected prostate volume, postoperative bladder irrigation time, postoperative catheter indwelling time and hospitalization time as well as the international prostate symptom scores (IPSS), quality of life (QoL), maximum flow rate (Qmax), postvoid residual urine volume (PVR), prostate specific antigen (PSA), and prostate volume (PV) before and at 1 month and 6 months after the operation were compared between the 2 groups. ResultsThe symptoms and quality of life of the patients improved significantly after the operation in both groups. Compared with those in TURP group, the patients in GreenLEP group had better postoperative Qmax (22.03±3.01 vs 19.08±2.62 mL/s, P<0.001) and IPSS (5.35±1.67 vs 7.92±2.19, P<0.001) with similar QoL, PVR, PSA, and PV. In patients with a PV no greater than 60 mL, the postoperative bladder irrigation time was significantly shorter in GreenLEP group than in TURP group (18.88±2.36 vs 34.33±2.90 h, P<0.001). In patients with a PV of 6080 mL, compared with the TURP group, the GreenLEP group had significantly less intraoperative blood loss (63.30±4.27 vs 77.28±6.19 mL, P<0.001) and shorter postoperative bladder irrigation time (23.11±1.91 vs 41.56±3.15 h, P<0.001) and postoperative hospital stay (3.07±0.61 vs 3.88±0.88 days, P<0.001) without significant differences in the operation time or prostatectomy volume. In patients with a PV beyond 80 mL, the assessed parameters in GreenLEP group were all superior to those in TURP group (P<0.001). The GreenLEP group recorded a significantly higher incidence of postoperative transient urinary incontinence but lower incidences of postoperative hyponatremia, sexual dysfunction, electrocut syndrome and postoperative blood transfusion than TURP group (P<0.05). ConclusionFor treatment of BPH, GreenLEP has similar therapeutic effect to TURP, but GreenLEP is associated with reduced intraoperative bleeding, shorter postoperative bladder irrigation time and postoperative hospital stay and lowered incidences of postoperative complications especially in patients with a large PV.
 

参考文献/References:

[1]CINDOLO L, PIROZZI L, FANIZZA C, et al. Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia:  populationbased cohort study[J]. Eur Urol, 2015, 68(3):  418-425. DOI: 10.1016/j.eururo.2014.11.006.

[2]ANDERSON B B, PARISER J J, HELFAND B T. Comparison of patients undergoing PVP versus TURP for LUTS/BPH[J]. Curr Urol Rep, 2015, 16(8):  1-8. DOI: 10.1007/s1193401505257.

[3]MORDASINI L, DI BONA C, KLEIN J, et al. 80W GreenLight laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic obstruction:  5year outcomes of a singlecenter prospective randomized trial[J]. Urology, 2018, 116:  144-149. DOI: 10.1016/j.urology.2018.01.037.

[4]MALEK R S, BARRETT D M, KUNTZMAN R S. Highpower potassiumtitanylphosphate (KTP/532) laser vaporization prostatectomy:  24 hours later[J]. Urology, 1998, 51(2):  254-256. DOI: 10.1016/S00904295(97)006134.

[5]CHO S, KWON S S, LEE K W, et al. A multicenter reallife study of the efficacy of an alphablocker with or without anticholinergic agent (imidafenacin) treatment in patients with lower urinary tract symptoms/benign prostatic hyperplasia and storage symptoms[J]. Int J Clin Pract, 2017, 71(5):  e12938. DOI: 10.1111/ijcp.12938.

[6]ELASSMY A, ELSHAL A M, MEKKAWY R, et al. Erectile and ejaculatory functions changes following bipolar versus monopolar transurethral resection of the prostate:  a prospective randomized study[J]. Int Urol Nephrol, 2018, 50(9):  1569-1576. DOI: 10.1007/s1125501819506.

[7]JIANG Y L, QIAN L J. Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia:  a metaanalysis[J]. BMC Urol, 2019, 19(1):  1-8. DOI: 10.1186/s1289401904401.

[8]YANG E J, LI H, SUN X B, et al. Bipolar versus monopolar transurethral resection of the prostate for benign prostatic hyperplasia:  safe in patients with high surgical risk[J]. Sci Rep, 2016, 6:  21494. DOI: 10.1038/srep21494.

[9]何幸福, 田彬, 李见波. 经尿道双极等离子前列腺电切术治疗前列腺增生症的疗效及对患者尿道功能与机体功能的影响[J]. 转化医学电子杂志, 2017, 4(8):  58-60. DOI: 10.3969/j.issn.20956894.2017.08.018.

HE X F, TIAN B, LI J B. Efficacy of transurethral bipolar plasma kinetic resection of the prostate for treatment of benign prostatic hyperplasia and its effect on patients’ urethral function and body function[J]. J Transl Med, 2017, 4(8):  58-60. DOI: 10.3969/j.issn.20956894.2017.08.018.

[10]THANGASAMY I A, CHALASANI V, BACHMANN A, et al. Photoselective vaporisation of the prostate using 80W and 120W laser versus transurethral resection of the prostate for benign prostatic hyperplasia:  a systematic review with metaanalysis from 2002 to 2012[J]. Eur Urol, 2012, 62(2):  315-323. DOI: 10.1016/j.eururo.2012.04.051.

[11]GONG Y G, LIU R M, GAO R. Photoselective vaporesection of the prostate with a frontfiring lithium triborate laser:  surgical technique and experience after 215 procedures[J]. Eur Urol, 2015, 67(6):  1152-1159. DOI: 10.1016/j.eururo.2014.12.021.

[12]陈晖, 汤平, 欧汝彪, 等. 开放前列腺切除术与经尿道前列腺电切术治疗大体积前列腺增生安全性的Meta分析[J]. 实用医学杂志, 2012, 28(11):  1800-1802. DOI: 10.3969/j.issn.10065725.2012.11.019.

CHEN H, TANG P, OU R B, et al. Metaanalysis of transurethral resection of the prostate versus open prostatectomy for benign prostatic hyperplasia with large volume prostate[J]. J Pract Med, 2012, 28(11):  1800-1802. DOI: 10.3969/j.issn.10065725.2012.11.019.

[13]EREDICS K, WACHABAUER D, RTHLIN F, et al. Reoperation rates and mortality after transurethral and open prostatectomy in a longterm nationwide analysis:  have we improved over a decade?[J]. Urology, 2018, 118:  152-157. DOI: 10.1016/j.urology.2018.04.032.

[14]MISRAI V, KEREVER S, PHE V, et al. Direct comparison of GreenLight laser XPS photoselective prostate vaporization and GreenLight laser en bloc enucleation of the prostate in enlarged glands greater than 80 mL:  a study of 120 patients[J]. J Urol, 2016, 195(4 Pt 1):  1027-1032. DOI: 10.1016/j.juro.2015.10.080.

[15]KUMAR N, VASUDEVA P, KUMAR A, et al. Prospective randomized comparison of monopolar TURP, bipolar TURP and photoselective vaporization of the prostate in patients with benign prostatic obstruction:  36 months outcome[J]. Luts:  Low Urin Tract Symptoms, 2018, 10(1):  17-20. DOI: 10.1111/luts.12135.

[16]RIEKEN M, ANTUNESLOPES T, GEAVLETE B, et al. What is new with sexual side effects after transurethral male lower urinary tract symptom surgery?[J]. Eur Urol Focus, 2018, 4(1):  43-45. DOI: 10.1016/j.euf.2018.05.001.

[17]刘正超, 蒋涛, 陈志朋, 等. 绿激光直出式剜除和选择性汽化治疗良性前列腺增生症患者的随机对照研究[J]. 第三军医大学学报, 2020, 42(5):  511-516. DOI:  10.16016 / j.10005404.201911198.

LIU Z C, JIANG T, CHEN Z P, et al. Green light topfiring sharpenucleation of prostate versus photoselective vaporisation of prostate for benign prostatic hyperplasia:  a randomized controlled trial[J]. J Third Mil Med Univ, 2020, 42(5):  511-516. DOI:  10.16016 / j.10005404.201911198.

更新日期/Last Update: 2020-09-22