[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。
【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.
1. Bushman W. Etiology, epidemiology, and natural history of benign prostatic hyperplasia [J]. Urol Clin North Am, 2009, 36: 403-415.
2. Patel A, Adshead JM. First clinical experience with new transurethral bipolar prostate electrosurgery resection system: controlled tissue ablation (coblation technology) [J]. J Endourol, 2004, 18:959-964.
3. Bhansali M, Patankar S, Dobhada S et al. Management of large (>60 g) prostate gland: PlasmaKinetic Superpulse (bipolar) versus conventional (monopolar) transurethral resection of the prostate [J]. J Endourol, 2009, 23:141-145.
4. Cornu JN, Ahyai S, Bachmann A et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update [J]. Eur Urol. doi: 10.1016/j.eururo.2014.06.017.
5. Kavanagh LE, Jack GS, Lawrentschuk N et al. Prevention and management of TURP-related hemorrhage [J]. Nature reviews Urology, 2011, 8:504-514.
6. Alschibaja M, May F, Treiber U et al. Recent improvements in transurethral high-frequency electrosurgery of the prostate [J]. BJU Int, 2006, 97:243-246.
7. Oelke M, Bachmann A, Descazeaud A et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction [J]. Eur Urol, 2013, 64:118-140.
8. Naspro R, Suardi N, Salonia A et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up [J]. Eur Urol, 2006, 50:563-568.
9. Liao N, Yu J. A study comparing plasmakinetic enucleation with bipolar plasmakinetic resection of the prostate for benign prostatic hyperplasia [J]. J Endourol, 2012, 26:884-888.
10. Autorino R, Damiano R, Di Lorenzo G et al. Four-year outcome of a prospective randomised trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate [J]. Eur Urol, 2009, 55:922-929.
11. Xu A, Zou Y, Li B et al. A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia [J]. J Endourol, 2013, 27:1254-1260.
12. Chen CH, Chiang PH, Lee WC et al. High-intensity diode laser in combination with bipolar transurethral resection of the prostate: a new strategy for the treatment of large prostates (>80 ml) [J]. Lasers in surgery and medicine, 2012, 44:699-704.
13. Yang SS, Hsieh CH, Chiang IN et al. Prostate volume did not affect voiding function improvements in diode laser enucleation of the prostate [J]. J Urol, 2013, 189:993-998.
14. Leonardi R. Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique [J]. Prostate Cancer Prostatic Dis, 2009, 12:277-280.
