Comparison of clinical efficacy between transurethral plasma enucleation of the prostate and holmium laser enucleation for the treatment of giant prostatic hyperplasia
-
摘要: 目的 对比经尿道前列腺等离子剜除术与钬激光剜除术治疗巨大前列腺增生的临床疗效。方法 选择2021年8月-2022年12月马鞍山市人民医院和南京医科大学第二附属医院270例巨大前列腺增生患者进行本次研究, 按照随机数表法分为研究组(132例)和对照组(138例), 对照组采用经尿道前列腺等离子剜除术治疗, 研究组采用钬激光剜除术治疗。比较2组围术期指标, 最大尿流率(Qmax)、前列腺特异性抗原(PSA), 生活质量(QOL)评分、国际前列腺症状评分(IPSS)、国际勃起功能指数-5(IIEF-5)评分, 不良反应发生率。结果 研究组留置导尿管时间、血红蛋白(Hb)、手术时间、膀胱冲洗时间、住院时间均显著低于对照组[(2.86±0.69) d vs (7.90±1.32) d, (9.79±1.08) g/L vs (15.86±3.20) g/L, (89.27±19.36) min vs (118.37±26.58) min, (1.28±0.32) d vs (3.97±0.50) d, (5.19±0.51) d vs (9.29±1.38) d], 差异均有统计学意义(P < 0.05)。研究组Qmax显著高于对照组[(17.03±3.27) mL/s vs (12.39±2.08) mL/s]; 研究组QOL、IPSS评分显著低于对照组[(1.51±0.62)分vs (2.68±0.73)分, (9.21±0.80)分vs (15.90±0.96)分], IIEF-5评分显著低于对照组[(21.70±0.92)分vs (17.62±0.80)分], 研究组不良反应发生率显著低于对照组[9.09%(12/132) vs 16.67%(23/138)], 差异均有统计学意义(P < 0.05)。结论 经尿道前列腺等离子剜除术与钬激光剜除术在治疗巨大前列腺增生均具有一定的治疗效果, 但钬激光剜除术可缩短手术时间, 减少出血, 提高尿道通畅, 改善勃起功能, 不良反应少, 安全有效。
-
关键词:
- 经尿道前列腺等离子剜除术 /
- 钬激光剜除术 /
- 巨大前列腺增生
Abstract: Objective To compare the clinical efficacy between transurethral plasma enucleation of the prostate and holmium laser enucleation for the treatment of giant prostatic hyperplasia.Methods From August 2021 to December 2022, 270 patients with giant prostatic hyperplasia who received treatment in Ma'anshan People's Hospital and The Second Affiliated Hospital of Nanjing Medical University were selected for this study, and they were divided into study group (n=132) and control group (n=138) according to random number table method. The control group was treated with transurethral plasma enucleation of the prostate, while the study group used holmium laser enucleation surgery for treatment. The perioperative indicators, maximum urinary flow rate, prostate specific antigen, QOL, IPSS, IIEF-5 scores, and incidence of adverse reactions were compared between two groups.Results The retention time of catheter, Hb, operation time, bladder flushing time and hospital stay in the study group were significantly lower than those in the control group ([2.86±0.69] d vs [7.90±1.32] d, [9.79±1.08] g/L vs [15.86±3.20] g/L, [89.27±19.36] min vs [118.37±26.58] min, [1.28±0.32] d vs [3.97±0.50] d, [5.19±0.51] d vs [9.29±1.38] d, P < 0.05). The Qmax of the study group was significantly higher than that of the control group ([17.03±3.27] mL/s vs [12.39±2.08] mL/s, P < 0.05). The QOL and IPSS scores of the study group were significantly lower than those of the control group ([1.51±0.62] scores vs [2.68±0.73] scores, [9.21±0.80] scores vs [15.90±0.96] scores, P < 0.05). The IIEF-5 score was significantly lower than the control group ([21.70±0.92] scores vs [17.62±0.80] scores, P < 0.05). The incidence of adverse reactions in the study group was significantly lower than that in the control group (9.09%[12/132]vs 16.67%[23/138], P < 0.05).Conclusion Both transurethral plasma enucleation of the prostate and holmium laser enucleation have certain therapeutic effects on the treatment of giant prostatic hyperplasia. However, holmium laser enucleation is safe and effective for it can shorten the surgical time, reduce bleeding, improve urethral patency, improve erectile function, reduce adverse reactions. -
-
表 1 2组围术期指标比较
X±S 组别 例数 留置导尿管时间/d Hb/(g/L) 手术时间/min 膀胱冲洗时间/d 住院时间/d 研究组 132 2.86±0.69 9.79±1.08 89.27±19.36 1.28±0.32 5.19±0.51 对照组 138 7.90±1.32 15.86±3.20 118.37±26.58 3.97±0.50 9.29±1.38 t 39.057 20.694 10.245 52.392 32.100 P值 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 
下载: 导出CSV
表 2 2组Qmax、PSA对比结果
X±S 组别 例数 Qmax/(mL/s) PSA/(μg/L) 术前 术后6个月 术前 术后6个月 研究组 132 9.89±1.21 17.03±3.271) 3.18±0.92 2.35±0.611) 对照组 138 9.68±1.16 12.39±2.081) 3.21±0.95 2.38±0.621) t 1.456 13.974 0.263 0.401 P值 0.147 < 0.001 0.792 0.689 与术前比较，1)P < 0.05。
下载: 导出CSV
表 3 2组QOL、IPSS、IIEF-5评分对比结果
分，X±S 组别 例数 QOL IPSS IIEF-5 术前 术后6个月 术前 术后6个月 术前 术后6个月 研究组 132 3.79±0.38 1.51±0.621) 26.98±0.37 9.21±0.801) 9.72±0.61 21.70±0.921) 对照组 138 3.82±0.39 2.68±0.731) 27.02±0.39 15.90±0.961) 9.83±0.65 17.62±0.801) t 0.640 14.165 0.864 62.062 1.432 38.934 P值 0.523 < 0.001 0.388 < 0.001 0.153 < 0.001 与术前比较，1)P < 0.05。
下载: 导出CSV
表 4 2组不良反应发生率比较
例(%) 组别 例数 泌尿系统感染 血尿 尿失禁 尿道狭窄 总发生率 研究组 132 3(2.27) 5(3.79) 4(3.03) 0 12(9.09) 对照组 138 6(4.35) 8(5.80) 3(2.17) 6(4.35) 23(16.67) χ2 3.432 P值 0.064
下载: 导出CSV
-
[1] de Assis AM, Moreira AM, Carnevale FC, et al. Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience[J]. Radiol Bras, 2021, 54(4): 219-224. doi: 10.1590/0100-3984.2020.0096
[2] Ojewola RW, Tijani KH, Fatuga AL, et al. Management of a giant prostatic enlargement: Case report and review of the literature[J]. Niger Postgrad Med J, 2020, 27(3): 242-247. doi: 10.4103/npmj.npmj_69_20
[3] 张石军, 刘玉刚, 刘龙, 等. 经尿道等离子腔内前列腺剜除术对良性前列腺增生患者尿动力学指标、COX-2、VEGF水平的影响[J]. 临床医学研究与实践, 2022, 7(16): 78-81. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202216022.htm
[4] 方子轩. 经尿道前列腺等离子双极电切术与钬激光前列腺剜除术的疗效和安全性比较[D]. 汕头大学, 2022.
[5] 张祥华, 王行环, 王刚, 等. 良性前列腺增生临床诊治指南[J]. 中华外科杂志, 2007, 45(24): 1704-1707. doi: 10.3760/j.issn:0529-5815.2007.24.018
[6] 高健, 张勇, 欧阳昀, 等. 比较微拉激光与等离子技术治疗良性前列腺增生的疗效及安全性[J]. 医学食疗与健康, 2022, 20(10): 10-13. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL202210004.htm
[7] 迟庆龙, 张守利. 巨大前列腺采用经尿道钬激光前列腺剜除术对比经尿道前列腺切除术的效果研究[J]. 智慧健康, 2022, 8(9): 69-71. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHJK202209023.htm
[8] 蔡兰辉. 经尿道前列腺等离子剜除术治疗前列腺增生的有效性及安全性探析[J]. 中外医疗, 2022, 41(12): 85-89. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ202212021.htm
[9] 王树林, 于乐广, 田宁宁, 等. 影响钬激光前列腺剜除术中出血的多因素分析[J]. 临床泌尿外科杂志, 2022, 37(1): 61-65. https://lcmw.chinajournal.net.cn/WKC/WebPublication/paperDigest.aspx?paperID=cba92748-ccf6-4859-96ca-858f1deb5230
[10] 彭英峰. 经尿道双极等离子前列腺剜除术与经尿道等离子前列腺切除术治疗前列腺增生症对比[J]. 世界复合医学, 2021, 7(8): 83-86. https://www.cnki.com.cn/Article/CJFDTOTAL-SJFH202108021.htm
[11] 张鹏. 良性前列腺增生合并组织学慢性前列腺炎患者血清PSA水平与下尿路症状相关性分析[J]. 医学理论与实践, 2021, 34(12): 2012-2014. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202112012.htm
[12] Kably I, Bode A. Intractable hematuria due to giant prostatic hyperplasia effectively treated with prostatic artery embolization[J]. Asian J Urol, 2020, 7(3): 318-321.
[13] 刘正超, 沈文浩. 经尿道前列腺剜除术治疗良性前列腺增生的应用进展[J]. 临床泌尿外科杂志, 2020, 35(5): 409-412. https://lcmw.chinajournal.net.cn/WKC/WebPublication/paperDigest.aspx?paperID=0a26fe8a-12d0-4bc5-8494-393ac341d8e1
[14] 黄敏志, 黄裕清, 余自强, 等. 经尿道等离子剜除术治疗巨大良性前列腺增生的疗效观察[J]. 现代泌尿生殖肿瘤杂志, 2017, 9(1): 29-32. https://www.cnki.com.cn/Article/CJFDTOTAL-PXDM201701008.htm
[15] Igbokwe MC, Salako AA, Badmus TA, et al. Simple Prostatectomy for Giant Benign Prostatic Hyperplasia in Sub-Saharan Africa: Case Series and Literature Review[J]. West Afr J Med, 2021, 38(5): 498-501.
[16] 刘可, 张帆, 颜野, 等. 经尿道钬激光前列腺剜除术后早期尿失禁与膜性尿道长度的相关性研究[J]. 中华泌尿外科杂志, 2023, 44(1): 21-25.
-