目的 揭示初学者进行经尿道前列腺钬激光剜除术的真实过程, 探讨其学习曲线和体会。方法 应用100W钬激光和组织粉碎器对80位良性前列腺增生症的患者行经尿道钬激光前列腺剜除术和组织粉碎术。将80例患者分为前40例和后40例两组, 比较两组间患者年龄、前列腺体积、手术时间、Hb变化、术后近期并发症等指标, 分别进行统计学处理。结果 第二组手术时间较短, 手术效率较高, 且对于血红蛋白的影响要小于第一组(P<0.01)。第二组中转等离子切除术的比率要远小于第一组。输血、组织粉碎致膀胱损伤、术后继发血尿、尿道狭窄、压力性尿失禁两组间无显著差异。术后三个月, 两组患者的IPSS、Qmax较术前有显著改善(P<0.01), 平均PSA较术前显著下降。两组之间比较, 术后三个月IPSS、Qmax、PSA无统计学差异。结论 初学者行经尿道钬激光前列腺剜除术40例后, 手术技巧、手术安全性有显著提高。在前40例, 应选择体积小的前列腺进行手术。经过20-40例的练习, 多能掌握基本的剜除技术。
Objective To reveal the learning curve of holmium laser enucleation of the prostate (HoLEP).Methods Eighty patients with BPH underwent HoLEP were enrolled in study.To reflect our learning curve of HoLEP,we separated the patients into two groups (initial 40 cases and last 40 cases).Results The operation time was shorter and enucleation rate was higher in the second group (last 40 cases).The first group (initial 40 cases) had a higher rate of switching to plasmakinetic resection of the prostate (PKRP) during operation and a higher decrease in Hb postoperatively.Complications such as blood transfusion,bladder injury during morcellation,hematuria,urethral stricture,stress urinary incontinence between two groups were comparable.Both two groups had a significant improvement in IPSS and Qmax and a 70% decrease in PSA at three month follow-up.And the mean improvement between two groups was statistically nonsignificant.Conclusion After 40 cases of learning HoLEP,the new learner had a significant improvement in surgical technique and safety.
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