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目的:对比分析经尿道半导体激光前列腺剜除术(DIOD)与前列腺电切术(TURP)治疗不同体积良性前列腺增生(BPH)的临床疗效。方法:回顾性分析2012年3月至2015年8月本院收治的256例BPH患者,其中141例采用DIOD,115例采用TURP。术前按前列腺体积大小分为3组,<60 ml组中42例行DIOD术,31例行TURP术;60~80 ml组中51例行DIOD术,45例行TURP术;>80 ml组中48例行DIOD术,39例行TURP术;对比分析3组患者两种治疗方法的临床疗效,各组围手术期平均手术时间、血红蛋白变化率、Na+变化率、膀胱冲洗时间、留置尿管时间,以及术前术后血清PSA、IPSS评分、最大尿流率(Qmax)、残余尿(PVR)等指标变化。结果:<60 ml组围手术期各项指标及术后随访指标在两种手术方法间无明显差异;60~80 ml组中DIOD组血红蛋白变化[(3.25±1.53)g/L]、Na+变化[(3.58±1.27)mmol/L]、冲洗时间[(30.06±6.22)h]、留置尿管时间[(47.61±13.55)h]明显优于TURP组[(4.77±1.67)g/L、(9.67±2.67)mmol/L、(58.32±10.25)h、(68.01±9.69)h](P<0.05),DIOD组术后PSA下降大于TURP组[(2.34±1.29)μg/L vs(1.09±0.72)μg/L,P<0.05];>80 ml组中DIOD组术后PSA下降大于TURP组[(3.35±1.39)μg/L vs(1.76±0.91)μg/L,P<0.05)],且围手术期各项指标明显优于TURP组(P<0.05或P<0.01)。DIOD组无输血、经尿道电切综合征、尿道狭窄等并发症发生,但假性尿失禁发生率高于TURP组(22.70%vs 7.83%)(P<0.01)。结论:DIOD治疗BPH短期疗效确切,具有出血少、恢复快、安全性高的特点。在中、大体积前列腺中优势明显,而对小体积前列腺与TURP疗效相当。
Objective: To compare the clinical effects of transurethral diode laser prostatectomy (DIOD) and transurethral resection of the prostate (TURP) in the treatment of different volumes of benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was performed on 256 patients with BPH admitted to our hospital from March 2012 to August 2015, of whom 141 received DIOD and 115 received TURP. According to the volume of prostate, the patients were divided into 3 groups according to the volume of prostate, 42 patients underwent DIOD and 31 patients underwent TURP in 60 ml, 51 patients underwent DIOD and 45 patients underwent TURP in 60 to 80 ml, and 80 ml 48 cases underwent DIOD and 39 cases underwent TURP. The clinical curative effect of the two treatment methods were compared among the three groups. The average operation time, hemoglobin change rate, Na + change rate, bladder irrigation time, indwelling catheter Time, and preoperative and postoperative serum PSA, IPSS score, maximum flow rate (Qmax), residual urine (PVR) and other indicators. Results: There was no significant difference in the perioperative parameters between the 60 ml group and the postoperative follow-up index between the two methods. The changes of hemoglobin in DIOD group were (3.25 ± 1.53) g / L in 60-80 ml group, Na + [(3.58 ± 1.27) mmol / L], duration of flushing [(30.06 ± 6.22) h] and indwelling catheter time (47.61 ± 13.55 h) were significantly better than those of TURP group [(4.77 ± 1.67) g / 9.67 ± 2.67 mmol / L, 58.32 ± 10.25 h, 68.01 ± 9.69 h, P <0.05). The postoperative PSA level in DIOD group was significantly lower than that in TURP group [(2.34 ± 1.29) μg / L vs (1.09 ± 0.72) μg / L, P <0.05]. The PSA in DI80 group was significantly lower than that in TURP group (3.35 ± 1.39 μg / L vs 1.76 ± 0.91 μg / L, P <0.05) The perioperative indicators were significantly better than the TURP group (P <0.05 or P <0.01). However, the incidence of pseudo-incontinence in DIOD group was higher than that in TURP group (22.70% vs 7.83%, P <0.01). No complications were found in DIOD group such as transurethral resection syndrome and urethral stricture. Conclusion: The short-term curative effect of DIOD in the treatment of BPH is definite, with less bleeding, quick recovery and high safety. In the large, large prostate obvious advantages, while the small size of the prostate and TURP curative effect.