【作者】 沈文浩；

【导师】 熊恩庆；

【作者基本信息】 第三军医大学 ， 外科学， 2003， 硕士

【摘要】 目的：比较前列腺钬激光剜除术（HoLEP）和经尿道前列腺电切术（TURP）近期临床疗效，期望对前列腺钬激光剜除术做出较为全面、客观的评价，为该技术的临床应用提供依据。方法：将2001年11月至2002年10月满足本课题病例纳入标准和剔除标准的良性前列腺增生症（BPH）患者随机分为两组，分别行 HoLEP和TURP，得到HoLEP组和TURP组各70例。前瞻性设计两组患者术前、术中、术后及术后3月、6月复查指标，通过将所测指标进行统计学分析，比较两种术式治疗BPH的近期临床疗效。结果：术后3月、6月均来我科复查者，HoLEP组55例，TURP组58例。（1）术前两组患者年龄、病史、前列腺重量、前列腺指肛检查结果、合并症情况及IPSS、QOLS、Qmax、Pdet/Qmax、残余尿（RUV）比较无显著差异（P>0.05）；（2）术后3、6月，两组患者IPSS、QOLS、Qmax、Pdet/Qmax、RUV均比术前得到明显改善（P<0.01），改善程度两组间无显著差异（P>0.05）；（3）手术时间及尿道狭窄、再手术率、逆行射精等近期术后并发症两组间无显著差异（P>0.05）；但术中输血率、TURS发生率、术后平均膀胱冲洗时间、置管时间和住院时间，HoLEP组明显小于TURP组（P<0.01）。结论：（1）HoLEP治疗良性前列腺增生症具有与TURP相同的近期临床疗效；（2）术中并发症发生率及患者术后恢复时间，HoLEP明显少于TURP；（3）HoLEP是目前BPH激光疗法中最有望替代TURP的一种新方法，其远期疗效有待进一步观察。更多还原

【Abstract】 Objective: To get an all around, objective assessment on holmium laser enucleation of the prostate (HoLEP) ,which is a new technique on the treatment of benign prostatic hyperplasia (BPH) in our country, through comparing therapy results in the near future of HoLEP with thansurethal resection of the prostate(TURP) directly. Methods: In the randomized comparison, we made out the indexes which would be monitored and recorded during the research prospectively. A total of 140 men with symptomatic BPH and meeting the criterions of the research were treated with either HoLEP or TURP during the period from November 2001 to Octorber 2002 in our center, thus the patients were divided into two groups: Group HoLEP and Group TURP, 70 patients each group. Standard assessments including International Prostate Symptom Score(IPSS), Quality of Life Score(QOLS), prostate specific antigen(PSA), digital rectal examination, pressure-flow urodynamics，ultrasound prostate volume and post-voiding residual urine measurement were performed in each patient preoperatively. Operation time , postoperative bladder irrigating time and catheterizing time were recorded. IPSS, QOLS, uroflometry were repeated respectively at both 3 and 6- months visit. Pressure-flow urodynamics was also repeated at 6 months postoperatively. All complications were noted. The data was performed statistical analysis.Results: 55 patients in Group HoLEP and 58 in Group TURP were visited at both 3 and 6 months.There was no significant difference between the two groups for any preoperative parameter. Both holmium laser and transurethral resections resulted in significant improvements in IPSS, QOLS, peak urinary flow rate(Qmax), detrusor pressure at Qmax(Pdet/Qmax) and post-voiding residual urine volumn(RUV). The degree of improvements was similar between the two groups(P>0.05). Operation time was almost equivalent but postoperative bladder irrigating time, catheterizing time and admission days of HoLEP group were significant less compared to the TURP group. There were fewer side effects such as blood transfusion, transurethral resection syndrome(TURS) in the holmium<WP=5>group. Effects on retrograde ejaculation, urethral stricture and reoperation rate were similar with 6-months followup.Conclusions: (1) HoLEP is as effective as TURP for the treatment of symptomatic BPH in the near future according to our research results. (2) HoLEP yields fewer adverse side effects and less recovering time compared to TURP. (3)HoLEP may be a substitute for TURP.更多还原