经尿道钬激光前列腺剜除术治疗良性前列腺增生的学习曲线研究

黄龙; 朱蜀侠; 王宇; 刘东亮; 胥艳; 李响

doi:10.13201/j.issn.1001-1420.2020.05.002

经尿道钬激光前列腺剜除术治疗良性前列腺增生的学习曲线研究

- 1. 三六三医院泌尿外科(成都, 610041);
- 2. 四川大学华西医院泌尿外科
基金项目:
四川省卫健委科研基金资助(No:18PJ457)

详细信息

通讯作者: 朱蜀侠,E-mail:zhushuxia23@qq.coma

中图分类号: R697

收稿日期: 2019-06-25

Study on the learning curve of holmium laser enucleation of prostate for benign prostatic hyperplasia

- 1. Department of Urology, 363 Hospital, Chengdu, Sichuan, 610041, China;
- 2. Department of Urology, West China Hospital, Sichuan University

More Information

Corresponding author: ZHU Shuxia, E-mail: zhushuxia23@qq.coma

Received Date: 25 June 2019

摘要

摘要: 目的:总结并探讨连续实施经尿道钬激光前列腺剜除术(HoLEP)治疗良性前列腺增生(BPH)的安全性、效率及学习曲线。方法:回顾性分析2017年5月~2018年6月我院1位熟练掌握经尿道前列腺电切术(TURP)的泌尿外科医师采用HoLEP治疗99例BPH患者的临床资料。按手术先后顺序,以连续的每33例患者为一组分为A、B、C三组,记录并对比手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Q_max),对比前列腺体积、手术时间、剜除效率、尿管留置时间、术后尿失禁、术后尿道狭窄情况及术后膀胱颈挛缩情况。结果:三组患者手术时间、剜除效率、术后尿管留置时间比较差异均有统计学意义(P<0.05)。A组平均手术时间(97.03±18.09) min,B组平均手术时间(83.00±19.12) min,C组平均手术时间(64.72±7.37) min。A组平均剜除效率(0.71±0.15) mL/min,B组平均剜除效率(1.06±0.25) mL/min,C组平均剜除效率(1.22±0.23) mL/min。A组平均尿管留置时间(4.55±0.56) d,B组平均尿管留置时间(4.03±0.65) d,C组平均尿管留置时间(3.21±0.49) d。三组手术前后IPSS、QOL、Q_max、血红蛋白(Hb)下降值比较差异无统计学意义。术后尿失禁发生27例,主要发生于A、B组,均于术后3个月内恢复。中转TURP共5例,主要出现在A组,膀胱损伤1例发生于A组。结论:HoLEP治疗BPH效果确切,通过33例可掌握该手术,66例后手术技术进入比较稳定的平台期,手术效率及安全性显著提高,初学者宜选取前列腺体积<60 mL病例实施手术。
- 良性前列腺增生 /
- 经尿道钬激光前列腺剜除术 /
- 学习曲线
Abstract: Objective: To analyze the safety, efficiency and learning curve of holmium laser enucleation of prostate(HoLEP) for the treatment of benign prostatic hyperplasia(BPH). Method: We retrospectively reviewed data on 99 consecutive patients with BPH who underwent HoLEP performed by one experienced urologic doctor( having surgical experience of transurethral resection of prostate on more than 600 cases) from May 2017 to June 2018. All cases were divided into three groups, A, B and C, with each consecutive group of 33 patients. International Prostate Symptom Score(IPSS), quality of life(QOL), maximum urine flow rate(Q_max), prostate volume, operation time, enucleation efficiency, indwelling catheter time, postoperative urinary incontinence, postoperative urethral stricture, postoperative bladder neck contracture were recorded and analyzed for each group. Result: There was statistically significant difference among the three groups in operation time, enucleation efficiency and postoperative indwelling catheter time, and there was statistically significant difference between each two groups in the difference analysis.The average operation time in group A was(97.03±18.09) minutes, that in group B was(83.00±19.12) minutes, and that in group C was(64.72±7.37) minutes. The average enucleation efficiency was(0.71±0.15) mL/min in group A,(1.06±0.25) mL/min in group B, and(1.22±0.23) mL/min in group C. The mean indwelling catheter time in group A was(4.55±0.56) days, the mean indwelling catheter time in group B(4.03±0.65) days, and the mean indwelling catheter time in group C(3.21±0.49) days. There was no statistically significant difference in IPSS, QOL, Q_max or Hb before and after surgery.Postoperative urinary incontinence occurred in 27 patients, mainly in group A and group B.All patients with urinary incontinence recovered within 3 months after surgery. TURP was converted in 5 patients, mainly in group A. Bladder injury occurred in one patient in group A.Conclusion: HoLEP is effective in the treatment of BPH. HoLEP can be learnt after trainingon 33 cases.After trainingon 66 cases,the surgical technique can reach a more efficient, safer and stablerlevel. Beginners should be able to perform surgery on patients with less than 60 mL of prostate.
- benign prostatic hyperplasia /
- holmium laser enucleation of prostate /
- learning curve

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