2022 年第 2 期 第 17 卷

钬激光和等离子前列腺剜除术后前列腺增生患者的短期预后比较

Comparison of short-term prognosis after holmium laser and plasma enucleation of prostate in patients with benign prostatic hyperplasia

作者：丁华佳陈珊蒋青青

英文作者：Ding Huajia Chen Shan Jiang Qingqing

单位：浙江省人民医院泌尿外科，杭州310014

英文单位：Department of Urology Surgery Zhejiang Provincial People′s Hospital Hangzhou 310014 China

关键词：前列腺增生；钬激光前列腺剜除术；等离子前列腺剜除术

英文关键词：Benignprostatichyperplasia;Holmiumlaserenucleationofprostate;Plasmaenucleationofprostate

• 摘要：

• 目的  比较钬激光和等离子前列腺剜除术后前列腺增生患者的短期预后情况。方法  回顾性分析2016年9月至2018年12月浙江省人民医院收治的100例前列腺增生患者的临床及随访资料。根据手术方法分为对照组和观察组，各50例。观察组行钬激光前列腺剜除术，对照组行等离子前列腺剜除术。记录2组手术指标及术后并发症发生情况，比较2组手术前后炎性因子、疼痛介质水平、国际前列腺症状评分（IPSS）、生活质量评分（QOL评分）及最大尿流率。结果  观察组手术时间长于对照组，术中出血量少于对照组，术后膀胱冲洗时间、住院时间短于对照组，术后并发症发生率低于对照组［22.0%（11/50）比38.0%（19/50）］（均P＜0.05）。2组术后24 h血清肿瘤坏死因子α、白细胞介素6、高敏C反应蛋白、前列腺素E2、P物质及5-羟色胺水平均高于术前，但观察组均低于对照组（均P＜0.05）。术后3个月，2组IPSS、QOL评分均低于术前，且观察组均低于对照组［（6.3±2.1）分比（8.0±2.3）分、（1.41±0.36）分比（1.64±0.23）分］；最大尿流率均高于术前，且观察组高于对照组［（22.2±4.1）ml/s比（19.4±5.2）ml/s］（均P＜0.05）。结论  与等离子前列腺剜除术相比，钬激光前列腺剜除术可减少患者术中出血量，降低炎性因子和疼痛介质水平，缩短住院时间，且安全性较高。

• Objective To compare the short-term prognosis after holmium laser and plasma enucleation of prostate in patients with benign prostatic hyperplasia (BPH). Methods From September 2016 to December 2018, the clinical and follow-up data of 100 patients with BPH admitted to Zhejiang Provincial People′s Hospital were retrospectively analyzed. According to surgical approaches, patients were divided into control group and observation group, with 50 cases in each group. The observation group received holmium laser enucleation of prostate and the control group received plasma enucleation of prostate. The surgical indexes and the incidences of postoperative complications of the two groups were recorded. The inflammatory factors, pain mediators levels, international prostate symptom score (IPSS), quality of life (QOL) score and maximum urinary flow rate were compared between the two groups before and after surgery. Results In observation group, the surgical time was longer than that in control group, intraoperative blood loss was less than that in control group, bladder flushing time and length of stay were shorter than those in control group, and the incidence of postoperative complications was lower than that in control group［22.0%（11/50） vs 38.0%（19/50）］(all P<0.05). Serum levels of tumor necrosis factor-α, interleukin-6, high sensitivity C-reactive protein, prostaglandin E2, substance P and 5-hydroxytryptamine in both groups 3 months after surgery were higher than those before surgery, while those in observation group were lower than those in control group (all P<0.05). Three months after surgery, IPSS and QOL score in both groups were lower than those before surgery, and those in observation group were lower than those in control group［（6.3±2.1） vs （8.0±2.3）,（1.41±0.36） vs （1.64±0.23）］; maximum urinary flow rate in the two groups was higher than that before surgery, and that in observation group was higher than that in control group［（22.2±4.1）ml/s vs （19.4±5.2）ml/s］(all P<0.05). Conclusion Compared with plasma enucleation of prostate, holmium laser enucleation of prostate can reduce intraoperative blood loss, inflammatory factors and pain mediators levels of patients, and shorten length of stay, with high safety. mso-bidi-language:AR-SA'>）U/L］, and the differences were significant different (all P<0.05). ROC curve analysis showed that the area under the curve for AAPR predicting hepatitis B cirrhosis was 0.901(95% confidence interval: 0.855-0.947, P<0.001), the best cut-off value was 0.41, the sensitivity was 76.0% and the specificity was 92.5%. Conclusion AAPR has certain predictive value in hepatitis B cirrhosis.