Influence of lower urinary tract symptoms on quality of life in patients after thulium fiber laser lobes-enucleation of the prostate
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摘要: 目的 探究经尿道前列腺铥光纤激光分叶剜除术(ThuLLEP)术后短期内患者储尿期、排尿期症状变化规律及其对生活质量的影响。方法 收集2020年7月—2021年7月在我院行ThuLLEP、具有完整随访资料的前列腺增生患者45例，分析术前、术后1个月、术后3个月的国际前列腺症状评分(IPSS)、储尿期症状评分(IPSS-S)、排尿期症状评分(IPSS-V)和生活质量评分(QOL)，以及手术前后最大尿流率(Qmax)和残余尿(PVR)，记录手术并发症。结果 45例患者平均年龄(67.2±6.9)岁，前列腺体积(70.5±28.9) mL，手术时间55(45.0，77.5) min，膀胱冲洗时间3.3(2.8，3.9) d，尿管留置时间4.8(3.9，5.6) d，术后住院时间5.0(5.0，6.0) d，血红蛋白下降值9.0(1.0，15.5) g/L。术后1例患者行输血治疗，出现1例膀胱血凝块填塞，3例短暂性尿失禁，3例尿道狭窄。术后的IPSS总分、IPSS-S、IPSS-V、QOL、Qmax和PVR与术前比较均明显改善，差异有统计学意义(P < 0.05)。多因素线性回归发现除术后1个月的IPSS-V外，手术前后的IPSS-S和IPSS-V均对QOL有明显影响(P < 0.05)，其中IPSS-S对QOL影响最显著。同时术后1个月、3个月的IPSS-S变化值和术后3个月的IPSS-V变化值对QOL的改善有明显影响(P < 0.05)，其中IPSS-S变化值对QOL的改善影响最大。结论 ThuLLEP能明显改善患者下尿路症状，术后排尿期症状改善程度优于储尿期症状。手术前后储尿期症状对QOL的影响均大于排尿期症状，术后储尿期症状的缓解是QOL改善的主要原因。Abstract: Objective To explore the change rule of storage and voiding symptoms and investigate their effects on short-term quality of life after thulium fiber laser lobes-enucleation of the prostate (ThuLLEP).Methods A total of 45 patients with benign prostatic hyperplasia who received ThuLLEP in our hospital from July 2020 to July 2021 and had complete follow-up data were collected. The international prostate symptom score (IPSS), storage symptom score (IPSS-S), voiding symptom score (IPSS-V), quality of life (QOL), preoperative and postoperative maximum urinary flow rate (Qmax) and postvoid residual volume (PVR) were analyzed. Surgical complications were also recorded.Results The mean age of 45 patients was (67.2±6.9) years old, and the prostate volume was (70.5±28.9) mL. The operation time was 55 (45.0, 77.5) min, and the postoperative bladder irrigation time was 3.3 (2.8, 3.9) d. The catheter indwelling time was 4.8 (3.9, 5.6) d, and the postoperative hospital stay was 5.0 (5.0, 6.0) d. The decreased hemoglobin was 9.0 (1.0, 15.5) g/L. There were 1 case of postoperative blood transfusion, 1 case of bladder blood block, 3 cases of transient urinary incontinence and 3 cases of urethral stricture after the operation. Postoperative IPSS score, IPSS-S, IPSS-V, QOL, Qmax and PVR were significantly improved compared with preoperative data. The difference was statistically significant (P < 0.05). Multivariate linear regression showed that all IPSS-S and IPSS-V had significant effects on QOL (P < 0.05) except IPSS-V at 1 month after surgery. IPSS-S had the most significant effect on QOL. Meanwhile, the change value of IPSS-S at 1 and 3 months after surgery and the change value of IPSS-V at 3 months after surgery had significant influence on the decrease of QOL (P < 0.05). The change value of IPSS-S had the greatest influence on the decrease of QOL.Conclusion ThuLLEP can alleviate the lower urinary tract symptoms significantly and the postoperative voiding symptoms were improved much better than storage symptoms. The storage symptoms had a greater influence on QOL scores than voiding symptoms. The alleviation of postoperative storage symptoms is the important factor for the improvement of QOL.
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表 1 手术前后IPSS、QOL评分
分，X±S 指标 术前 术后1个月 术后3个月 P IPSS-总 24.6±6.9 11.6±5.71) 9.3±5.61) < 0.05 IPSS-S 10.6±3.1 7.5±3.41) 5.4±2.71) < 0.05 IPSS-V 14.0±4.6 4.1±3.51) 3.9±3.71) < 0.05 QOL 5.1±0.9 2.4±1.31) 2.0±1.21) < 0.05 与术前比较，1)P < 0.05。 
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表 2 手术前后Qmax、PVR结果
M(Q1，Q3) 时间 Qmax/(mL·s-1) PVR/mL 术前 8.7(5.6，11.5) 87.0(45.5，166.5) 术后1个月 15.3(5.9，21.2) 21.0(0，35.5) P < 0.05 < 0.05
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表 3 手术前后IPSS对QOL的影响
变量 单因素 多因素 B 95% CI P B 95% CI P 术前 IPSS-S 0.156 0.085~0.227 < 0.001 0.101 0.018~0.184 < 0.05 IPSS-V 0.104 0.055~0.152 < 0.001 0.064 0.026~0.121 < 0.05 术后1个月 IPSS-S 0.212 0.116~0.309 < 0.001 0.186 0.084~0.288 < 0.05 IPSS-V 0.137 0.031~0.243 < 0.05 0.072 -0.028~0.172 > 0.05 术后3个月 IPSS-S 0.326 0.230~0.419 < 0.001 0.210 0.127~0.292 < 0.001 IPSS-V 0.244 0.179~0.309 < 0.001 0.167 0.107~0.227 < 0.001
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表 4 术后IPSS变化值对QOL改善的影响
变量 单因素 多因素 B 95%CI P B 95%CI P 术后1个月 IPSS-S变化值 0.208 0.112~0.304 < 0.001 0.165 0.059~0.271 < 0.05 IPSS-V变化值 0.128 0.051~0.205 < 0.05 0.070 -0.100~0.150 > 0.05 术后3个月 IPSS-S变化值 0.247 0.134~0.359 < 0.001 0.155 0.029~0.281 < 0.05 IPSS-V变化值 0.143 0.080~0.207 < 0.001 0.095 0.023~0.166 < 0.05
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