“两点一线一面”的手术原则在钬激光前列腺剜除术中的应用研究

李凌; 彭泳涵; 王则宇; 刘敏; 明少雄; 王祁衡; 高小峰

doi:10.13201/j.issn.1001-1420.2017.04.002

“两点一线一面”的手术原则在钬激光前列腺剜除术中的应用研究

- 第二军医大学附属长海医院泌尿外科, (上海, 200433)

详细信息

通讯作者: 高小峰, E-mail:gxfdoc@sina.com

中图分类号: R697.3

收稿日期: 2017-02-14

Research on the effect of “two points,one border and one layer” principle on the holmium laser enucleation of prostate surgery

- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China

More Information

Corresponding author: GAO Xiaofeng, E-mail: gxfdoc@sina.com

Received Date: 14 February 2017

摘要

摘要: 目的:探讨“两点一线一面”的手术原则在钬激光前列腺剜除术 (HoLEP) 中的疗效。方法:回顾性分析2015年6月²016年10月我院收治的BPH行HoLEP的患者临床资料, 所有患者均按照“两点一线一面”的剜除原则实施HoLEP。收集患者基础情况、围术期指标、术前术后排尿评价指标的变化以及手术并发症等资料, 评价按照“两点一线一面”的原则实施HoLEP的疗效。结果:研究共纳入78例患者。术前前列腺体积 (68.1±21.0) ml, 总体手术时间 (51.74±18.6) min, 剜除时间 (42.74±17.6) min, 组织粉碎时间 (8.2±7.5) min, 剜除速度 (1.4±0.4) g/min, 术后住院 (2.4±2.0) d。术后1个月随访表明, 前列腺特异性抗原 (PSA) 降低81.3%, 前列腺症状评分 (IPSS) 改善34.7%, 生活质量评分 (QOL) 提高57.1%, 最大尿流率 (Q_max) 上升97.8%, 剩余尿量 (PVR) 减少51.2%。拔管当日尿失禁发生率23.1% (18/78) , 其中14例为急迫性尿失禁, 4例为压力性尿失禁。术后1周时, 仅1例患者仍有轻度急迫性尿失禁;该患者通过提肛锻炼至术后3个月完全恢复。2例患者发生中叶轻度包膜穿孔;无严重出血并发症发生。结论:“两点一线一面”的剜除原则凝练了HoLEP手术方式的基本原则, 治疗前列腺增生安全、有效, 同时在又具有良好的灵活性操作性, 易于广大泌尿外科医师学习、掌握和推广。
- 良性前列腺增生 /
- 钬激光前列腺剜除术
Abstract: Objective:To evaluate the effect of "two points, one border and one layer"principle on holmium laser enucleation of prostate (HoLEP).Method:Data from consecutive benign prostatic hypertrophia (BPH) patients between June 2015 and October 2016 were retrospectively reviewed.All cases were performed HoLEP surgery following the "two points, one border and one layer"principle.The basic characteristics, perioperative parameters, pre-and postoperative voiding function parameters as well as perioperative complications were all collected in order to evaluate the effect of the novel principle applied on HoLEP.Result:A total of 78 patients were enrolled in the current study, and they had an average prostate volume of (68.1±21.0) ml.The overall operation time was (51.74±18.6) min.The enucleation time was (42.74±17.6) min and the morcellating time was (8.2±7.5) min.The average enucleation speed was (1.4±0.4) g/min by calculating.The average postoperative stay was (2.4±2.0) days.On the one month follow-up, PSA, and PVR dropped by 81.3% and 51.2%, respectively, while IPSS score, QOL score and Q_maximproved by 34.7%, 57.1% and 97.8%, respectively.The incontinence rate was 23.1% (18/78) on the second postoperative day when catheters were removed.Among the incontinence cases, 14 patients presented urge incontinence while 4patients had stress incontinence.The incontinence rate rapidly decreased to 1.3% (1/78) by the end of one week after the surgery, and the remaining one patient who had a mild urge incontinence also recovered through levator ani exercises three months after the surgery.No severe complications such as transfusion were observed except that two patients suffered from mild middle lobes'capsula perforation.Conclusion:The "two points, one border and one layer"HoLEP principle captures the bases of HoLEP treatment, and is proved to be safe, effective as well as flexible in the treatment of BPH.Thus it is likely to be accepted by urologists and has a wide development prospect.
- benign prostatic hypertrophia /
- holmium laser enucleation of prostate

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参考文献(20)

[1]	Woodard T J, Manigault K R, McBurrows N N, et al.Management of benign prostatic hyperplasia in older adults[J].Consult Pharm, 2016, 31 (8):412-424.
[2]	Vincent M W, Gilling P J.HoLEP has come of age[J].World J Urol, 2015, 33 (4):487-493.
[3]	Ruszat R, Seitz M, Wyler S F, et al.GreenLight laser vaporization of the prostate:single-center experience and long-term results after 500 procedures[J].Eur Urol, 2008, 54 (4):893-901.
[4]	Lerner L B, Rajender A.Laser prostate enucleation techniques[J].Can J Urol, 2015, 22 (1):53-59.
[5]	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 (1):118-140.
[6]	Herrmann T R, Liatsikos E N, Nagele U, et al.EAU guidelines on laser technologies[J].Eur Urol, 2012, 61 (4):783-795.
[7]	Nickel J C, Saad F.The American Urological Association 2003guideline on management of benign prostatic hyperplasia:a Canadian opinion[J].Can J Urol, 2004, 11 (2):2186-2193.
[8]	Gilling P J, Wilson L C, King C J, et al.Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate:results at 7years[J].BJU Int, 2012, 109 (3):408-411.
[9]	Razzak M.BPH:HoLEP——a steep learning curve but better for patients[J].Nat Rev Urol, 2013, 10 (2):66.
[10]	Cornu J N.Bipolar, monopolar, photovaporization of the prostate, or Holmium laser enucleation of the prostate:how to choose what's best?[J].Urol Clin North Am, 2016, 43 (3):377-384.
[11]	Brunckhorst O, Ahmed K, Nehikhare O, et al.Evaluation of the learning curve for holmium laser enucleation of the prostate using multiple outcome measures[J].Urology, 2015, 86 (4):824-829.
[12]	Shah H N, Mahajan A P, Hegde S S, et al.Peri-operative complications of holmium laser enucleation of the prostate:experience in the first 280patients, and a review of literature[J].BJU Int, 2007, 100 (1):94-101.
[13]	Kahokehr A A, Gilling P J.Which laser works best for benign prostatic hyperplasia?[J].Curr Urol Rep, 2013, 14 (6):614-619.
[14]	Minagawa S, Okada S, Sakamoto H, et al.En-Bloc technique with anteroposterior dissection holmium laser enucleation of the prostate allows a short operative time and acceptable outcomes[J].Urology, 2015, 86 (3):628-633.
[15]	Scoffone C M, Cracco C M.The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique[J].World J Urol, 2016, 34 (8):1175-1181.
[16]	Ahyai S A, Chun F K, Lehrich K, et al.Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy——which procedure is faster?[J].J Urol, 2012, 187 (5):1608-1613.
[17]	Li S, Zeng X T, Ruan X L, et al.Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia:an updated systematic review with meta-analysis and trial sequential analysis[J].PLoS One, 2014, 9 (7):e101615.
[18]	Elshal A M, Mekkawy R, Laymon M, et al.Holmium laser enucleation of the prostate for treatment for largesized benign prostate hyperplasia;is it a realistic endourologic alternative in developing country?[J].World J Urol, 2016, 34 (3):399-405.
[19]	Takiuchi H, Nakao A, Ihara H.Prevention of transient urinary incontinence in peri-operative period of modified holmium laser enucleation of the prostate (HoLEP)[J].Hinyokika Kiyo, 2008, 54 (7):475-478.
[20]	Endo F, Shiga Y, Minagawa S, et al.Anteroposterior dissection HoLEP:a modification to prevent transient stress urinary incontinence[J].Urology, 2010, 76 (6):1451-1455.