Comparative analysis of transurethral thulium laser enucleation versus transurethral columnar balloon dilatation for BPH
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摘要: 目的 评估与对比经尿道铥激光前列腺剜除术(ThuLEP)与经尿道柱状水囊前列腺扩开术(TUDP)治疗良性前列腺增生(BPH)12个月内的临床疗效。方法 本研究回顾性分析2020年2月—2021年4月于我院因BPH行手术治疗的128例患者的临床资料，其中67例行ThuLEP，61例行TUDP。收集患者术前、围手术期、术后3个月和12个月的临床资料。术前两组间临床指标的差异通过倾向性评分评估和稳健逆概率处理加权校正，通过广义估计方程分析对比两组间术后重复测量的疗效差异。结果 围手术期指标中，ThuLEP组术后住院时长、膀胱持续冲洗时长和导尿管留置时长均相较于TUDP组显著更短(P < 0.05)，手术时长则显著更长(P < 0.01)；术后12个月，ThuLEP组的生活质量(QoL)评分、最大尿流率(Qmax)和膀胱残余尿量(PVR)均相较于TUDP组显著更优(P < 0.05)；两组术后并发症的发生率比较差异无统计学意义(P>0.05)。结论 ThuLEP与TUDP均可有效治疗BPH；ThuLEP相较于TUDP的多项围手术期和术后指标均显著更优。
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关键词:
- 良性前列腺增生 /
- 经尿道铥激光前列腺剜除术 /
- 经尿道柱状水囊前列腺扩开术
Abstract: Objective To evaluate and compare clinical outcomes over 12 months for benign prostatic hyperplasia(BPH) treated with transurethral thulium laser enucleation of the prostate (ThuLEP) or transurethral columnar balloon dilatation of the prostate (TUDP).Methods This study retrospectively analysed 128 patients of BPH from February 2020 to April 2021 in our hospital. Among them, 67 patients underwent ThuLEP, and 61 patients underwent TUDP. Preoperative, intraoperative, 3-month postoperative, and 12-month postoperative clinical profiles were collected. Propensity score and inverse probability of treatment weighting were conducted to evaluate and adjust the preoperative difference between groups. Generalized estimating equations was applied to compare the repeated measured difference of outcomes between groups.Results Perioperative characteristics including postoperative stay, bladder irrigation time and catheterization time were significantly shorter in ThuLEP group than in TUDP group (P < 0.05), while operation time was significantly longer in ThuLEP group than in TUDP group (P < 0.01). Postoperative characteristics including quality of life (QoL) score, maximum urinary flow rate (Qmax), postvoid residual urine (PVR) were significantly favorable in ThuLEP group than TUDP group (P < 0.05). Postoperative complications were not significantly different between ThuLEP and TUDP groups (P > 0.05).Conclusion Our results demonstrated that both ThuLEP and TUDP possessed good efficacy and safety in treating BPH. While, ThuLEP showed superior strength in multiple peri-and postoperative indicators. -
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表 1 ThuLEP组和TUDP组患者的临床基线指标
X±S，M(P25，P75) 指标 SIPTW前 SIPTW后 ThuLEP组(67例) TUDP组(61组) P SMD ThuLEP组(69例) TUDP组(59例) P SMD 年龄/岁 72.25±7.25 75.15±6.25 0.018 0.427 73.86±6.97 74.02±6.62 0.906 0.023 PV/mL 69.96±14.77 66.33±11.55 0.127 0.274 66.38±15.12 66.96±11.56 0.832 0.044 PSA/(ng·mL-1) 2.95(1.93，4.03) 2.37(1.45，4.12) 0.222 0.178 2.72(1.39，3.84) 2.38(1.44，4.08) 0.966 0.024 IPSS 25.87±3.07 25.62±2.64 0.634 0.085 25.58±2.89 25.65±2.61 0.883 0.027 QoL/分 5(4，5.5) 4(4，6) 0.383 0.13 5(4，5) 4.5(4，6) 0.884 0.014 Qmax/(mL·s-1) 7.23±1.45 7.19±1.30 0.884 0.026 7.35±1.42 7.29±1.25 0.812 0.044 PVR/mL 70.59±11.57 68.01±12.07 0.221 0.218 67.76±12.65 68.59±11.89 0.749 0.067 
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表 2 ThuLEP组和TUDP组患者的围手术期指标比较
M(P25，P75) 组别 手术时长/min 手术出血量/mL 术后住院时长/d 膀胱持续灌洗时长/h 术后置管时长/d VAS评分/分 ThuLEP组 40(33，44) 26(20.5，34.5) 3(2，3) 13(12，14) 2(2，3) 2(1，2) TUDP组 29(25，32) 29(23，34) 5(4，6) 16(13，17) 4(4，5) 2(1，2) P < 0.01 0.163 < 0.01 < 0.01 < 0.01 0.215
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表 3 ThuLEP组和TUDP组患者术后指标比较
X±S，M(P25，P75) 组别 IPSS评分/分 QoL评分/分 Qmax/(mL·s-1) PVR/mL ThuLEP组(67例) 基线 25.58±2.89 5(4，5) 7.35±1.42 67.76±12.65 3个月 6.43±1.54 2(2，3) 28.08±3.61 18.17±5.58 12个月 6.72±1.63 2(1.5，2) 26.46±3.61 18.53±5.44 TUDP(61例) 基线 25.65±2.61 4.5(4，6) 7.29±1.25 68.59±11.89 3个月 6.87±1.12 2(2，3) 26.15±4.51 19.22±6.30 12个月 7.26±1.30 2(2，3) 24.20±4.64 21.36±6.66 P 0.098 0.036 < 0.01 < 0.01
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表 4 ThuLEP组和TUDP组患者术后并发症比较
例(%) 组别 尿失禁 二次出血 尿道感染 尿道狭窄 急性尿潴流 总并发症 ThuLEP组(67例) 9(13.43) 1(1.49) 4(5.97) 3(4.48) 1(1.49) 18(26.87) TUDP组(61例) 5(8.20) 2(3.28) 3(4.92) 1(1.64) 3(4.92) 14(22.95) P 0.343 0.605 1.000 0.621 0.347 0.609
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[1] Lim KB. Epidemiology of clinical benign prostatic hyperplasia[J]. Asian J Urol, 2017, 4(3): 148-151. doi: 10.1016/j.ajur.2017.06.004
[2] Zhong J, Feng Z, Peng Y, et al. A Systematic Review and Meta-analysis of Efficacy and Safety Following Holmium Laser Enucleation of Prostate and Transurethral Resection of Prostate for Benign Prostatic Hyper plasia[J]. Urology, 2019, 131: 14-20. doi: 10.1016/j.urology.2019.03.034
[3] Yan P, Cui Y, Huang Y, et al. Intraoperative and postoperative outcomes of thulium laser enucleation versus bipolar resection in the transurethral treatment of benign prostatic hyperplasia: a meta-analysis[J]. Lasers Med Sci, 2022, 37(5): 2517-2525. doi: 10.1007/s10103-022-03519-x
[4] 侯淑均, 刘红珍, 高博, 等. 经尿道柱状水囊前列腺扩开术与经尿道前列腺电切术的对比研究[J]. 中华全科医学, 2017, 15(3): 542-544. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201703056.htm
[5] Herrmann TR, Bach T, Imkamp F, et al. Thulium laser enucleation of the prostate(ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction[J]. World J Urol, 2010, 28(1): 45-51. doi: 10.1007/s00345-009-0503-0
[6] 高文喜, 余扬, 朱旋, 等. 经尿道柱状水囊前列腺扩开术治疗BPH的临床应用经验[J]. 中华泌尿外科杂志, 2020, 41(8): 603-608. doi: 10.3760/cma.j.cn112330-20181112-00592
[7] Bozzini G, Seveso M, Melegari S, et al. Thulium laser enucleation(ThuLEP)versus transurethral resection of the prostate in saline(TURis): A randomized prospective trial to compare intra and early postoperative outcomes[J]. Actas Urol Esp, 2017, 41(5): 309-315. doi: 10.1016/j.acuro.2016.06.010
[8] 杨康, 张贤生. 两种手术方式治疗高危良性前列腺增生症患者的临床对比分析[J]. 中国男科学杂志, 2021, 35(5): 71-74. https://www.cnki.com.cn/Article/CJFDTOTAL-NXXX202105014.htm
[9] Bach T, Netsch C, Haecker A, et al. Thulium: YAG laser enucleation(VapoEnucleation)of the prostate: safety and durability during intermediate-term follow-up[J]. World J Urol, 2010, 28(1): 39-43. doi: 10.1007/s00345-009-0461-6
[10] 夏术阶, 张沂南, 鲁军, 等. 铥激光"剥橘"式切除术治疗良性前列腺增生症[J]. 中华医学杂志, 2005, (45): 62-65. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYX200545017.htm
[11] 杨勇, 洪宝发, 魏志涛, 等. 经尿道2 μm激光前列腺汽化切除术治疗大体积良性前列腺增生的初步经验[J]. 中华泌尿外科杂志, 2009, 30(3): 198-201. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC201905019.htm
[12] 伊庆同, 张杰, 龚旻, 等. 经尿道铥激光前列腺剜除术与汽化切除术治疗高危大体积良性前列腺增生的疗效分析[J]. 中国男科学杂志, 2018, 32(4): 46-50. https://www.cnki.com.cn/Article/CJFDTOTAL-NXXX201804011.htm
[13] 刘加升. 带定位囊的前列腺扩开导管的研制与应用[J]. 中国现代手术学杂志, 2015, 19(1): 78-79. https://www.cnki.com.cn/Article/CJFDTOTAL-XDSS201501028.htm
[14] 王立民, 胡锦洋, 李立坤, 等. 经尿道柱状水囊前列腺扩开术治疗良性前列腺增生的临床疗效分析[J]. 中华男科学杂志, 2021, 27(2): 150-154. https://www.cnki.com.cn/Article/CJFDTOTAL-NKXB202102012.htm
[15] Zhou G, He J, Huang G, et al. Efficacy and Safety of Transurethral Columnar Balloon Dilation of the Prostate for the Treatment of Benign Prostatic Hyperplasia: A Multicenter Trial[J]. Comput Math MethodsMed, 2022, 2022: 7881247.
[16] 王充, 苗晓林, 连文峰, 等. 超声引导下经尿道柱状水囊前列腺扩开术治疗前列腺增生[J]. 微创泌尿外科杂志, 2018, 7(4): 263-266. https://www.cnki.com.cn/Article/CJFDTOTAL-WCMN201804013.htm
[17] 刘甜甜, 康健, 李杜渐, 等. 经尿道柱状水囊前列腺扩裂术的疗效分析[J]. 临床泌尿外科杂志, 2022, 37(6): 470-473. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW202206014.htm
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