红激光与等离子经尿道前列腺剜除术治疗大体积良性前列腺增生的疗效及安全性比较

外科研究与新技术 ›› 2015, Vol. 4 ›› Issue (2): 71-74.

• 论著 • 下一篇

红激光与等离子经尿道前列腺剜除术治疗大体积良性前列腺增生的疗效及安全性比较

吴刚¹,黄盛松¹,吴登龙¹,卞崔东¹,袁涛²,桂亚平²,李超¹,王天如¹,罗华荣¹,刘博¹,张琪敏¹,李军亮¹,刘昭辉¹,洪哲¹

1. 同济大学附属同济医院
2. 同济医院

收稿日期:2015-04-27 修回日期:2015-05-03 出版日期:2015-06-28 发布日期:2015-07-06
通讯作者: 吴登龙 E-mail:wudenglong2013@126.com
基金资助:
国家自然科学基金;上海市教委创新重点项目

Comparative study of the safety and efficacy between diode laser enucleation and bipolar plasmakinetic enucleation for prostates larger than 80 ml

Received:2015-04-27 Revised:2015-05-03 Online:2015-06-28 Published:2015-07-06

摘要/Abstract

摘要： [摘要] 目的：比较经尿道前列腺红激光剜除术（diode laser enucleation of the prostate，DiLEP）和经尿道等离子红激光剜除术(bipolar plasmakinetic enucleation of the prostate，PKEP)治疗大体积前列腺增生（Benign prostatic hyperplasia，BPH）的疗效及安全性。方法：回顾性分析2012年6月到2014年1月收治的70例大体积BPH患者，分别采用等离子或红激光行经尿道前列腺剜除术。比较两组患者手术时间、血红蛋白下降值、手术前、后国际前列腺症状评分、残尿量、最大尿流率等指标变化。结果：两组患者手术均获成功，术后随访12个月。DiLEP组与PKEP组的IPSS、Qmax、QoL差异均无明显统计学意义，但两组均较术前有明显改善，差异有统计学意义（P<0.05）。DiLEP组在在术后血红蛋白下降值、膀胱灌注时间、留置尿管时间及住院时间均显著低于PKEP组。DiLEP组与PKEP组的手术时间[(123.5 ± 27.2)min与(102.7 ± 20.4)min]、切除组织重量[(64.7 ± 16.8)g与(61.2 ± 20.5)g]、术后血红蛋白下降值[(0.92 ± 0.43)g/dl与(1.24 ± 0.55)g/dl]、膀胱灌注时间[(28.9 ± 14)h与（38.5 ± 16.6）h]、导尿管留置时间[(2.6 ± 1.8)d与(3.8 ± 2.3)d]和住院时间[(4.84 ± 1.8)d与(6.2 ± 2.3)d]比较差异均有统计学意义（P<0.05）。两组术后均未发生经尿道电切综合征，PKEP组1例因术后出血给予输血治疗，DiLEP组无输血病例。两组的尿潴留、输血、压力性尿失禁等发生率比较差异均无统计学意义（P>0.05）。两组在刺激症状及逆行射精方面比较差异有统计学意义（P<0.05）。结论：与PKEP相比，DiLEP治疗大体积BPH出血风险更小，膀胱灌注、留置尿管及住院时间更短，具有良好的疗效及安全性。

关键词: 前列腺增生, 经尿道手术, 红激光剜除, 等离子剜除

Abstract: 【Abstract】 Objective We compared the safety and efficiency of diode laser enucleation with that of bipolar plasmakinetic enucleation for the treatment of large volume prostate (>80ml). Methods From June 2012 to January 2014，A total of 70 patients with lower urinary tract symptoms associated with large volume prostate were included in our study. Of these, 35 patients were treated with diode laser enucleation of the prostate. No significant differences were observed in the pre-operative data. All patients were preoperatively assessed and evaluated at 3, 6, and 12-months. Perioperative data and postoperative outcomes were compared. Immediate and late complications were also assessed. Results Both groups displayed significant improvements in IPSS, QoL and Qmax 12 month after surgery. However, we identified there was no significant differences between the two groups in the follow-up data (P>0.05). Patients treated with diode laser showed a lower risk of blood loss [(0.92 ± 0.43)g/dl vs (1.24 ± 0.55)g/dl], as well as shorter bladder irrigation [(28.9 ± 14)h vs（38.5 ± 16.6）h] and catheterization times [(2.6 ± 1.8)d vs (3.8 ± 2.3)d]. A larger amount of prostate tissue was retrieved in the DiLEP group, but the operation time of the diode laser group was longer than that of the bipolar plasmakinetic enucleation group [(123.5 ± 27.2)min vs (102.7 ± 20.4)min]. There was no significant difference in the rate of postoperative urinary retention, blood transfusion, reoperation and incidence of stress urinary incontinence (P>0.05). However, the diode laser group was significantly superior to bipolar plasmakinetic group in terms of the irritative symptoms and ejaculatory function in the postoperative period. Conclusions DiLEP provides more widely application range, less risk of haemorrhage, reduced bladder irrigation and catheter indwelling duration as well as reduced hospital stay. Diode laser enucleation of the prostate is a safe and effective method for the transurethral management of prostates larger than 80 ml.

Key words: Benign prostatic hyperplasia, Transurethral surgery, Plasma kinetic enucleation, didoe laser enucleation

吴刚黄盛松吴登龙卞崔东袁涛桂亚平李超王天如罗华荣刘博张琪敏李军亮刘昭辉洪哲. 红激光与等离子经尿道前列腺剜除术治疗大体积良性前列腺增生的疗效及安全性比较[J]. 外科研究与新技术, 2015, 4(2): 71-74.

参考文献

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红激光与等离子经尿道前列腺剜除术治疗大体积良性前列腺增生的疗效及安全性比较

Comparative study of the safety and efficacy between diode laser enucleation and bipolar plasmakinetic enucleation for prostates larger than 80 ml

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