120W PVP和等离子TURis治疗高龄高危BPH的随机对照临床研究

发布时间：2018-03-15 17:44

本文选题：良性前列腺增生　切入点：绿激光　出处：《广西医科大学》2014年博士论文　论文类型：学位论文

【摘要】：研究背景：近几十年来，已经有许多新技术被用来治疗良性前列腺增生（benignprostatic hyperplasia，BPH）患者，降低了手术风险并且取得了很好的疗效。绿激光选择性前列腺汽化术（greenlight photoselectivevaporization of the prostate，PVP）具有出血少、安全、有效的特点，能够解除BPH患者的下尿路症状（lower urinary tract symptoms，LUTS），目前PVP已经成为一种替代传统经尿道前列腺电切术（transurethralresection of the prostate，TURP）治疗BPH的方法。随着双极等离子技术的应用，经尿道等离子前列腺汽化切除术（transurethral resection ofprostate in saline，TURis）也已经显示出其并发症少的特点，并在早期疗效和短期随访结果与TURP具有相当的效果。研究目的：本研究旨在通过前瞻性临床随机对照研究（randomized controlledtrial）的方法，从临床疗效，安全性，住院成本等方面，，对比PVP、TURis与传统TURP治疗高龄高危BPH患者的效果，为临床实践提供高级别的证据。研究方法： 2011年7月至2013年12月间，有208例患者被随机分配到PVP组、TURis组和TURP组，其中PVP组60例，TURis组89例，TURP组59例。我们前瞻性地收集了患者的人口学资料、围手术期资料、手术并发症，术后1个月，3个月定期随访了患者的情况。用SPSS软件中的相关方法对比分析了各组间的数据结果。研究结果：所有患者均完成手术和术后3个月的随访，无失访患者。PVP组患者平均年龄75.7±5.5岁，TURis组患者平均年龄75.4±4.4岁，TURP组患者平均年龄74.8±4.6岁，各组间比较没有统计学差异（P＞0.05）。PVP组、TURis组和TURP组的患者的前列腺体积、术前血红蛋白，术前血清钠离子浓度、国际前列腺症状评分（IPSS）和生活质量评分（QoL）评分各组之间比较均没有统计学差异（P＞0.05）。PVP组和TURis组患者前列腺特异性抗原（PSA）比较有统计学差异（P=0.003），PVP组与TURP组患者PSA（P=0.056）、TURis组和TURP组患者PSA（P=0.378）比较均无统计学差异。 PVP组、TURis组和TURP组的手术时间112.3±39.1分钟、84.6±38.7分钟和100.1±56.3分钟，TURis组手术时间显著短于另外两组（P＜0.05），PVP组和TURP组手术时间（P=0.135）无统计学差异。PVP组患者术前血红蛋白、血清钠离子与术后比较无统计学差异（P=0.100、P=0.283）。TURis组和TURP组患者术前血红蛋白、血清钠离子与术后比较有统计学差异（P＜0.05）。PVP组的尿管留置时间显著短于TURis组和TURP组，差异有统计学意义（P＜0.05）。TURP组患者的住院时间显著长于PVP组和TURis组，有统计学差异（P＜0.05）。三组之间患者住院总费用均有显著统计学差异（P＜0.05），PVP组最高，TURis组最低。三组患者术后1月、3月随访IPSS和QoL评分与术前比较均有统计学差异（P＜0.05），组间比较无统计学差异（P＞0.05）。结论： PVP和TURis与TURP相比都能有效地减轻BPH患者LUTS症状、改善生活质量，同时相对于TURP具有操作简单、手术安全、并发症少的优点。而新一代的高功率120W绿激光治疗系统更具有出血少、恢复快、住院时间短的特点，是治疗高龄高危BPH患者理想的微创手术方法。
[Abstract]:Research background:
In recent decades, there have been many new technologies are used to treat benign prostatic hyperplasia (Benignprostatic, hyperplasia, BPH) of patients, reduce the risk of surgery and achieved good results. The green laser photoselective vaporization of the prostate (greenlight photoselectivevaporization of the prostate, PVP) with less bleeding, safe, effective, lower urinary tract the symptoms can relieve the patients with BPH (lower urinary tract symptoms, LUTS), PVP has already become an alternative to the traditional transurethral resection of prostate (Transurethralresection of the prostate, TURP) in the treatment of BPH. With the application of bipolar plasma technology, transurethral vaporization resection (transurethral resection ofprostate in saline, TURis) have shown the characteristics of less complications, and has a considerable effect on the early effects and short-term follow-up results with TURP.
The purpose of the study is:
The aim of this study is to compare the efficacy of PVP, TURis and traditional TURP in the treatment of elderly and high-risk BPH patients through the prospective randomized controlled clinical trial (randomized controlledtrial), from the aspects of clinical efficacy, safety and hospitalization costs, so as to provide advanced evidence for clinical practice.
Research methods:
From July 2011 to December 2013, 208 patients were randomly assigned to PVP group, TURis group and TURP group, including 60 cases of PVP group, TURis group of 89 cases, 59 cases in TURP group. We prospectively collected the patient demographic information, perioperative data, postoperative complications, 1 months after surgery, 3 a month of regular follow-up of the patient's condition. By using the correlation method in SPSS software were compared between groups of data.
The results of the study:
3 months of follow-up all patients completed the surgery and after surgery, no lost the average age of patients in the.PVP group were 75.7 + 5.5 years old, the average age of TURis group were 75.4 + 4.4 years old, the average age of TURP group were 74.8 + 4.6 years, there was no statistical difference between groups (P > 0.05) in.PVP group, TURis group and TURP group of patients with prostate volume, preoperative hemoglobin, preoperative serum sodium concentration, the International Prostate Symptom Score (IPSS) and quality of life score (QoL) scores were not statistically different between the groups (P > 0.05).PVP group and TURis group of patients with prostate specific antigen (PSA) is statistical difference (P=0.003), PVP group and TURP group PSA (P=0.056), TURis group and TURP group of patients with PSA (P=0.378) were no statistically significant difference.
In PVP group, the operation time of TURis group and TURP group were 112.3 + 39.1 minutes, 38.7 minutes and 84.6 + 100.1 + 56.3 minutes, the operation time of TURis group was significantly shorter than that in the other two groups (P < 0.05), PVP group and TURP group operation time (P=0.135) had no statistical difference of hemoglobin in the patients of the.PVP group, serum sodium ion and postoperative had no significant difference (P=0.100, P=0.283) in group.TURis and group TURP patients with preoperative hemoglobin, serum sodium and postoperative were statistically significant difference (P < 0.05) in.PVP group the catheter indwelling time was significantly shorter than that of TURis group and TURP group, the difference was statistically significant (P < 0.05) in hospital the time in.TURP group were significantly longer than PVP group and TURis group, there was significant difference (P < 0.05). The total cost of hospitalization between the three groups of patients had significant difference (P < 0.05), PVP group was the highest, the lowest in TURis group. The three groups of patients after January, compared with March follow-up with the preoperative QoL score and IPSS There were statistical differences (P < 0.05), and there was no statistical difference between groups (P > 0.05).
Conclusion:
PVP and TURis compared with TURP can effectively reduce BPH in patients with LUTS symptoms, improve the quality of life, compared to TURP has the advantages of simple operation, safe operation, less complications and high power 120W green laser treatment system of a new generation of more with less bleeding, quick recovery, short hospitalization time characteristics, minimally invasive surgery methods BPH patients with ideal treatment of high-risk.

【学位授予单位】：广西医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R699.8

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