经尿道钬激光前列腺剜除术治疗大体积良性前列腺增生

目的:评价经尿道钬激光前列腺剜除术(HoLEP)治疗大体积良性前列腺增生(BPH)的价值。方法:BPH患者60例,前列腺重量均>100g,分为HoLEP组(n=32)和耻骨上经膀胱前列腺切除术组(n=28),比较两组手术时间、术中出血量和术后膀胱冲洗时间、导尿管留置时间、住院时间;术后3个月随访,比较两组患者IPSS、生活质量评分(QOL)、最大尿流率(Qmax)、剩余尿量(PVR)等指标的变化。结果:HoLEP组与耻骨上经膀胱前列腺切除术组比较手术时间有所延长(P<0.01),但术中出血量减少(P<0.01),膀胱冲洗时间、导尿管留置时间、术后住院时间明显缩短(P<0.01)。术后3个月,两组IPSS、QOL、Qmax、PVR较自身术前显著改善(P<0.01),组间比较差异无显著性(P>0.05)。结论:HoLEP治疗大体积BPH具有与开放性前列腺切除术相似的疗效,同时手术安全性高、患者痛苦小、术后恢复快,是一种更适合于大体积BPH治疗的手术方式。

Transurethral Holmium Laser Enucleation for Prostate Adenoma Greater Than 100 g

OBJECTIVE: To evaluate the effect of transurethral holmium laser enucleation of the prostate (HoLEP) for prostate adenoma greater than 100 g. METHODS: Sixty BPH patients with the prostate larger than 100 g were randomized to two treatment groups of HoLEP (n = 32) and open prostatectomy (n = 28). Comparisons were made between the two groups in operating time, blood loss, bladder irrigating time, catheterization time and hospital stay, as well as in the international prostate symptom score (IPSS), quality of life (QOL) score, maximum urinary flow rate (Qmax) and postvoid residual volume (PVR) before and 3 months after the surgery. RESULTS: Compared with the open prostatectomy group, the operating time was significantly longer (P < 0.01) but the blood loss, mean bladder irrigating time, catheterization time and hospital stay were significantly less in the HoLEP group (P < 0.01). Three-month follow-up revealed that HoLEP and open prostatectomy resulted in a similarly significant improvement in IPSS, QOL, Qmax and PVR (P < 0.01 ), with no statistical difference between the two groups (P > 0.05). CONCLUSION: HoLEP and open prostatectomy are equally effective procedures for removal of large prostate adenomas, but the former is a better surgical option for prostate adenomas larger than 100 g for its greater safety, less pain and faster recovery.