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探讨经尿道前列腺钬激光剜除术(HoLEP)术中主动保护尿控功能的临床价值。方法:对HoLEP的细节上做出一些改良,主动地部分保留前列腺前括约肌和前列腺被动括约肌,记录患者术前、术中及术后随访的临床资料,分析及评估改良后HoLEP的疗效及安全性。结果:194例手术均成功,手术时间(74.50±21.24)(47~120)min,切除腺体(44.03±15.36)(31.5~116.8)g。术后3个月和6个月的IPSS、生活质量(QOL)评分、Qmax和剩余尿量(PVR)均有明显改善,差异均有统计学意义(P<0.05)。术后6个月复查,PSA平均下降80.1%(2.72ng/ml vs.0.56ng/ml);7例(3.61%)患者出现短期的压力性尿失禁;76例有性交者中22例出现逆行射精(28.95%)。结论:经改良的HoLEP疗效安全可靠,剜除彻底,短期尿失禁等并发症减少,有望成为治疗BPH的新的金标准。
To investigate the clinical value of proactive protection of urinary control in patients with transurethral holmium laser surgery (HoLEP). Methods: The details of HoLEP were modified to proactively retain the prostatic sphincter of the prostate and the passive sphincter of the prostate. The clinical data of the patients were recorded before, during and after operation. The curative effect and safety of the modified HoLEP were analyzed and evaluated . Results: All of the 194 cases were successful. The operation time was 74.50 ± 21.24 minutes and the number of resected glands was 44.03 ± 15.36 days (31.5-116.8) g. IPSS, quality of life (QOL) score, Qmax and residual urine volume (PVR) at 3 months and 6 months after operation were significantly improved (P <0.05). Postoperative 6 months review, PSA average decreased 80.1% (2.72ng / ml vs.0.56ng / ml); 7 patients (3.61%) patients with short-term stress urinary incontinence; 76 cases of sexual intercourse in 22 cases of retrograde Ejaculation (28.95%). Conclusions: The improved HoLEP is safe, reliable, and it is expected to be the new gold standard for the treatment of BPH due to the reduction of complications such as complete removal and short-term urinary incontinence.