摘要目的: 评价低功率（48 W、36 W）钬激光前列腺剜除术（LP-HoLEP）治疗良性前列腺增生症（BPH）的临床效果。方法: 入选三六三医院泌尿外科2017年8月–2019年8月收治的需手术治疗的BPH患者268例,采用随机数字法分为研究组和对照组,每组134例,研究组采用LP-HoLEP（48 W、36 W）进行手术,对照组采用B-TURP进行手术。比较两组手术时间、标本重量、术后血清Na+、术后血Hb、术后冲洗时间、留置尿管时间、住院时间、并发症发生率、术后1个月Qmax、IPSS、QOL以及PSA。另外,研究组70例分为A组,行48 W LP-HoLEP术,64例分为B组,行36 W LP-HoLEP术,比较A、B两组的手术时间、剜除效率、粉碎效率、标本重量、术后血Hb以及并发症发生率。结果: 研究组手术时间[(83.6±17.2) vs. (95.8±14.6)min,t=14.089,P=0.016]、标本重量[(59.7±12.1) vs. (42.6±11.3)g,t=16.416,P=0.012]、术后血清Na+[(142.3±4.7) vs. (131.4±3.1)mmol/L,t=11.368,P=0.018]、术后血Hb[(116.8±6.1) vs (101.6±7.4)g/L,t=19.573,P=0.007]、术后冲洗时间[(0.8±0.4) vs. (1.5±0.3)d,t=2.023,P=0.037]、留置尿管时间[(2.1±1.2) vs. (4.5±1.7)d,t=6.875,P=0.024]、住院时间[(3.8±1.6) vs. (6.7±2.1)d,t=7.316,P=0.021]、并发症发生率[38(28.4%) vs. 58(43.3%),χ2=10.821,P=0.019]与对照组相比较,差异有统计学意义（P<0.05）;研究组术后Qmax、IPSS、QOL、PSA与对照组相比较,差异无统计学意义（P>0.05）。A组手术时间、剜除效率、粉碎效率、标本重量、术后血Hb、并发症发生率与B组相比较,差异无统计学意义（P>0.05）。结论: LP-HoLEP（48 W、36 W）治疗BPH安全、有效,与TURP相当,其并发症发生率低,且使用低功率钬激光可以降低医疗成本,值得临床推广。
Abstract：Objective: To investigate the clinical effectiveness of low power holmium laser enucleation of the prostate （LP-HoLEP） for benign prostatic hyperplasia （BPH）. Methods： Totally, 268 patients during August 2017 to August 2019 were randomized into experimental group and control group （n = 134 each）. The experimental group received LP-HoLEP, and the control group received bi-polar transurethral resection of prostate （B-TURP）. The operation time, the weight of the specimens, postoperative serum Na+, postoperative blood Hb, the bladder irrigation time, the indwelling catheter time, the hospitalization days, the incidence of postoperative complications, postoperative Qmax, IPSS, QOL and PSA at 1-month follow-up were compared between the two groups. Subgroup analysis was carried out in experimental group： 70 patients undergoing 48-W LP-HoLEP （subgroup A）, and the rest 64 patients given 36-W LP-HoLEP （subgroup B）. The operation time, the enucleation efficiency, the morcellation efficiency, the weight of the specimens, postoperative blood Hb and the incidence of postoperative complications were compared between the two subgroups. Results： The operation time [（83.6 ± 17.2） vs. （95.8 ± 14.6） min, t = 14.089, P = 0.016], the weight of the specimens [（59.7 ± 12.1） vs. （42.6 ± 11.3） g, t = 16.416, P = 0.012], postoperative serum Na+ [（142.3 ± 4.7） vs. （131.4 ± 3.1） mmol/L, t = 11.368, P = 0.018]. postoperative blood Hb [（116.8 ± 6.1） vs. （101.6 ± 7.4） g/L, t = 19.573, P = 0.007], the bladder irrigation time [（0.8 ± 0.4） vs. （1.5 ± 0.3） d, t = 2.023, P = 0.037], the indwelling catheter time [（2.1 ± 1.2） vs. （4.5 ± 1.7） d, t = 6.875, P = 0.024], the hospitalization days [（3.8 ± 1.6） vs. （6.7 ± 2.1） d, t = 7.316, P = 0.021] and the incidence of postoperative complications [38 （28.4%） vs. 58 （43.3%）, χ2=10.821, P = 0.019] between the two groups were statistically significant （P<0.05）. The postoperative Qmax, IPSS, QOL and PSA at 1-month follow-up between the two groups showed no statistically significant differences （P>0.05）. In subgroup analysis, the operation time, the enucleation efficiency, the morcellation efficiency, the weight of the specimens, postoperative blood Hb and the incidence of postoperative complications between subgroup A and subgroup B showed no significant difference （P>0.05）. Conclusion： LP-HoLEP （48 W, 36 W） which had low incidence of postoperative complications had similar safety and efficacy to TURP, meanwhile, it could reduce medical cost, so it was worthy of clinical application.
王宇, 朱蜀侠, 李康, 黄龙. 低功率钬激光前列腺剜除术治疗良性前列腺增生症的疗效分析[J]. 微创泌尿外科杂志, 2021, 10(4): 267-272.
WANG Yu, ZHU Shuxia, LI Kang, HUANG Long. Clinical Effectiveness of Low Power Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(4): 267-272.
[1] KIRBY RS.The natural history of benign prostatic hyperplasia: what have we learned in the last decade? Urology, 2000,56(5 Suppl 1):3-6. [2] MICHALAK J, TZOU D, FUNK J.HoLEP: the gold standard for the surgical management of BPH in the 21(st) century. Am J Clin Exp Urol, 2015,3(1):36-42. [3] 唐汇龙,朱能,龙蠡,等.经尿道刀口变向钬激光前列腺剜除术治疗良性前列腺增生的疗效和安全性分析.中华泌尿外科杂志,2019,40(7):531-536. [4] 夏术阶,钱雨鑫,杨博宇.良性前列腺增生症激光治疗的昨天、今天、明天.现代泌尿外科杂志,2019,24(4):252-255. [5] IBRAHIM A, ALHARBI M, ELHILALI MM, et al.18 years of Holmium laser enucleation of the prostate: a single center experience. J Urol, 2019,202(4):795-800. [6] ELSHAL AM, EL-NAHAS AR, GHAZY M, et al.Low-Power Vs High-Power Holmium laser enucleation of the prostate: critical assessment through randomized trial. Urology, 2018,121:58-65. [7] MINAGAWA S, OKADA S, MORIKAWA H.Safety and Effectiveness of Holmium Laser Enucleation of the Prostate Using a Low-power Laser. Urology, 2017,110:51-55. [8] AHYAI SA, GILLING P, KAPLAN SA, et al.Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol, 2010, 58(3):384-397. [9] 覃江,韦克暖,蓝杰,等.激光和等离子技术在经尿道前列腺剜除术中的临床疗效应用进展.中外医疗,2019,38(12):196-198. [10] GILLING PJ, KENNETT K, DAS AK, et al.Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol, 1998,12(5):457-459. [11] GILLING PJ, WILSON LC, KING CJ, et al.Long-term results of a randomized trial comparing Holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int, 2012,109(3):408-411. [12] JHANWAR A, SINHA RJ, BANSAL A, et al.Outcomes of transurethral resection and Holmium laser enucleation in more than 60 g of prostate: A prospective randomized study. Urol Ann, 2017,9(1):45-50. [13] GU M, CHEN YB, LIU C, et al.Comparison of Holmium laser enucleation and plasmakinetic resection of prostate: a randomized trial with 72-Month Follow-Up. J Endourol, 2018,32(2):139-143. [14] ZHONG J, FENG Z, PENG YP, et al.A systematic review and meta-analysis of efficacy and safety following Holmium laser enucleation of prostate and transurethral resection of prostate for benign prostatic hyperplasia. Urology, 2019,131:14-20. [15] SESSLER D.Perioperative thermoregulation and heat balance. Ann N Y Acad Sci, 1997,813:757-777. [16] RASSWEILER J, RODER M, SCHULZE M, et al.Transurethral enucleation of the prostate with the Holmium: YAG laser system: how much power is necessary? Urologe A, 2008,47(4):441-448. [17] BECKER B, GROSS AJ, NETSCH C.Safety and efficacy using a low-powered holmium laser for enucleation of the prostate (HoLEP):12-month results from a prospective low-power HoLEP series. World J Urol, 2018,36(3):441-447. [18] KAMPANTAIS S, DIMOPOULOS P, TASLEEM A, et al.Assessing the learning curve of Holmium laser enucleation of prostate (HoLEP). A systematic review. Urology, 2018,120:9-22.
