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目的:比较分析经尿道前列腺电切术(TURP)及经尿道钬激光前列腺剜除术(Ho LEP)对合并膀胱逼尿肌活动过度的良性前列腺增生(BPH)的手术效果。方法:入组患者均为BPH合并膀胱逼尿肌活动过度,51例采用TURP,58例采用Ho LEP,评估两组患者在术后恢复期及术后3、6个月的排尿情况。结果:两组患者术前血PSA水平、前列腺体积、国际前列腺症状评分(IPSS)、生活质量(Qo L)评分无显著差异,但是膀胱有效容量TURP组[(315±59)ml]优于Ho LEP组[(287±76)ml](P<0.05)。术后评估两组患者储尿期症状均改善明显,TURP组IPSS评分中,储尿期评分从术前的(12.6±4.9)分降低到术后3个月的(7.5±3.9)分和术后6个月的(6.1±4.2)分;Ho LEP组储尿期评分从术前的(13.7±5.7)分降低到术后3个月的(7.9±4.2)分和术后6个月的(7.0±5.1)分,均有显著性差异(P均<0.01)。Ho LEP组术后留置导尿管天数[(2.7±0.8)d vs(5.1±1.2)d]、术后膀胱挛缩天数[(4.1±1.9)d vs(5.8±2.4)d]、术后住院天数[(4.4±1.8)d vs(5.9±2.5)d]、术后3个月患者最大尿流率的改善情况[Ho LEP组术前为(7.9±3.7)ml/s,术后3个月为(16.8±4.3)ml/s;TURP组术前为(8.6±3.2)ml/s,术后3个月为(14.6±4.3)ml/s]均优于TURP组,差异均有统计学意义(P均<0.05)。结论:TURP和Ho LEP均能改善膀胱功能和膀胱逼尿肌活动过度,在术后恢复期内,Ho LEP手术较有优势,但是在术后3个月及术后6个月,两组手术改善排尿情况接近。
Objective: To compare the surgical effects of transurethral resection of the prostate (TURP) and transurethral holmium laser lobectomy (Ho LEP) on benign prostatic hyperplasia (BPH) with detrusor overactivity. Methods: All the patients were enrolled in the study. The patients with BPH complicated with detrusor overactivity were over-active, TURP was used in 51 cases and Ho LEP was used in 58 cases. The urinary excretion in postoperative recovery period and postoperative 3 and 6 months were evaluated. Results: There was no significant difference in preoperative blood PSA level, prostate volume, IPSS, QoL scores between the two groups, but the bladder effective volume TURP group (315 ± 59) ml was superior to Ho LEP group [(287 ± 76) ml] (P <0.05). Postoperative evaluation of the two groups of patients with storage of urine symptoms were significantly improved, TURP group IPSS score, storage urinary score decreased from (12.6 ± 4.9) points before surgery to 3 months (7.5 ± 3.9) points and surgery (6.1 ± 4.2) in the first 6 months after operation; the storage urinary score in the Ho LEP group decreased from (13.7 ± 5.7) preoperatively to (7.9 ± 4.2) 3 months and postoperatively 6 months (7.0 ± 5.1) points, there was significant difference (all P <0.01). The number of postoperative urethral catheter days [(2.7 ± 0.8) d vs (5.1 ± 1.2) d], postoperative bladder contracture days [(4.1 ± 1.9) d vs (5.8 ± 2.4) d], postoperative hospital stay (4.4 ± 1.8) d vs (5.9 ± 2.5) d] and the improvement of maximal urinary flow rate at 3 months postoperatively in the LEP group (7.9 ± 3.7 ml / s preoperatively and 3 postoperatively (16.8 ± 4.3) ml / s for the month, (8.6 ± 3.2) ml / s for the TURP group and (14.6 ± 4.3) ml / s for the 3 months after surgery, respectively) Significance (P <0.05). CONCLUSION: Both TURP and Ho LEP can improve bladder function and bladder detrusor hyperactivity. In the postoperative recovery period, Ho LEP surgery has more advantages, but at 3 months and 6 months after surgery, Improve urination close to the situation.