经尿道钬激光前列腺剜除术与前列腺电切术近期疗效的对比分析

发布时间：2018-04-19 06:23

本文选题：良性前列腺增生 + 钬激光　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的针对良性前列腺增生患者接受两种手术方式（经尿道钬激光前列腺剜除术与经尿道前列腺电切术）后，对其手术时间、术后留置尿管时间、住院时间、术后并发症发生率、早期症状改善情况、手术前后最大尿流率、国际前列腺症状评分、生活质量评分等方面进行回顾性分析，对比两种手术方式的治疗效果。方法自2012年6月至2013年7月收集合肥市第一人民医院、合肥市第一人民医院蜀山分院及合肥市滨湖医院泌尿外科住院拟手术病人共有100例。就诊原因以排尿困难、尿频、尿急、尿痛等下尿路症状为主，在正规药物治疗无效后收住入院，排除糖尿病、帕金森综合症等一些可能致膀胱收缩无力的疾病后，行血清前列腺特异抗原、直肠指诊(DRE)、经直肠B超检查、残余尿量测量、最大尿流率检查并且术后病理结果提示为良性前列腺增生，以门诊就诊为主。年龄61～87岁，平均72.1岁，病程4～20年，平均13年。其中伴有膀胱结石病例14例。既往有尿潴留病史者37例，曾行导尿病例67例。患有高血压病史者32例，患有慢性支气管炎者10例，患有冠心病及心率失常者9例。将这100例患者以随机分组的方法分为两组，每组50人。分别行经尿道钬激光前列腺剜除术和经尿道前列腺电切术，，监测、记录2组患者术中出血量、经尿道电切综合征发生率、手术时间、膀胱冲洗时间、留管时间以及住院时间，并通过术后1个月、3个月及6个月复查指标，对比其最大尿流率、国际前列腺症状评分、生活质量评分等变化并进行相关分析，从而对比两者近期治疗效果。结果术前两组患者术前一般情况和最大尿流率、国际前列腺症状评分、生活质量评分以及前列腺重量比较，差异无统计学意义（P0.05）；在出血量比较中，经尿道钬激光前列腺剜除术组与经尿道前列腺电切术组相比，其出血量较低，两组差异有统计学意义(P0.05)；在经尿道电切综合征发生率上，经尿道钬激光前列腺剜除术组发生率明显低于经尿道前列腺电切术组，差异有统计学意义(P0.05)；在手术耗时、术后膀胱冲洗时间、导尿管留置天数及住院总天数的比较中，经尿道钬激光前列腺剜除术组与经尿道前列腺电切术组相比，其时间较短，差异有显著差异(P0.05)；术后1个月、3个月及6个月两组中国际前列腺症状评分、生活质量评分、最大尿流率与术前相比，均有明显改善（P0.05）；但两组间比较并无明显差异（P0.05）。结论经尿道钬激光前列腺剜除术与经尿道前列腺电切术相比，近期疗效相似，均可明显改善患者生活质量，但经尿道钬激光前列腺剜除术术后并发症较少，术后恢复较快，可视为治疗良性前列腺增生较好的新方法。
[Abstract]:Objective to investigate the time of operation, the time of indwelling urethral catheter, the time of hospitalization and the incidence of postoperative complications in patients with benign prostatic hyperplasia after transurethral holmium laser enucleation of the prostate and transurethral resection of the prostate.The improvement of early symptoms, the maximum urinary flow rate before and after operation, the international prostate symptom score and the quality of life score were analyzed retrospectively.Methods from June 2012 to July 2013, 100 patients were collected from Hefei first people's Hospital, Shushan Branch of Hefei first people's Hospital and Hefei Binhu Hospital.The main causes of the visit were dysuria, frequent urination, urgency, urinal pain, and other lower urinary tract symptoms. They were admitted to hospital after the failure of regular drug treatment, excluding diabetes mellitus, Parkinson's syndrome and other diseases that may cause bladder contraction weakness.Serum prostate-specific antigen (PSA), digital rectal diagnosis (DREN), transrectal B-mode ultrasonography, residual urine volume measurement, maximum uroflow rate examination and postoperative pathological results showed benign prostatic hyperplasia (BPH), mainly in outpatient clinic.The mean age was 72.1 years, and the course of disease ranged from 4 to 20 years (mean 13 years).Among them, 14 cases were accompanied with bladder calculi.There were 37 cases with history of urinary retention and 67 cases with urinary catheterization.There were 32 cases with history of hypertension, 10 cases with chronic bronchitis, 9 cases with coronary heart disease and arrhythmia.The 100 patients were randomly divided into two groups, 50 in each group.Transurethral holmium laser enucleation of the prostate and transurethral resection of the prostate were performed respectively. The amount of blood lost during the operation, the incidence of transurethral resection syndrome, the time of operation, the time of bladder irrigation, the time of stay of tube and the time of hospitalization were recorded.After 1 month, 3 months and 6 months after operation, the changes of maximal uroflow rate, international prostate symptom score and quality of life score were compared and analyzed.Results there was no significant difference between the two groups in preoperative general condition and maximal urine flow rate, international prostate symptom score, quality of life score and prostate weight (P 0.05).The bleeding volume of transurethral holmium laser enucleation of the prostate was lower than that of transurethral resection of the prostate (P 0.05), and the incidence of transurethral resection syndrome was higher than that of transurethral resection.The incidence of transurethral holmium laser enucleation of the prostate was significantly lower than that of transurethral resection of the prostate (P 0.05).The duration of transurethral holmium laser enucleation of the prostate was shorter than that of transurethral resection of the prostate (P 0.05), and the scores of international prostate symptom and quality of life were 1 month, 3 months and 6 months after operation.The maximum urinary flow rate was significantly improved compared with that before operation, but there was no significant difference between the two groups.Conclusion compared with transurethral holmium laser enucleation of the prostate, the short term curative effect is similar and the quality of life can be improved obviously. However, the complications after transurethral holmium laser enucleation of the prostate are less, and the recovery is faster after transurethral enucleation of the prostate.It can be regarded as a new method for the treatment of benign prostatic hyperplasia.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.8

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