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经尿道钬激光前列腺剜除术治疗症状性前列腺增生症3162例分析

Report of 3162 cases of holmium laser enucleation of the prostate and review

摘要:

目的 评价经尿道钬激光前列腺剜除术(HoLEP)治疗症状性前列腺增生症的疗效.方法 回顾性分析2001年8月至2011年8月间接受HoLEP手术并得到随访的3162例患者的临床资料,记录HoLEP手术时间(包括剜除时间和粉碎时间)、尿管留置时间、术后住院时间,评价手术前后最大尿流率、下尿路症状(LUTS)改善情况,对出血、术后排尿困难、尿潴留以及膀胱颈挛缩、尿道狭窄、残余腺体复发等近、远期并发症进行评估.结果 HoLEP手术均顺利完成,未发生经尿道电切综合征,手术操作时间平均(61±18)min,平均切除前列腺质量(45 ±24)g,患者手术前、后血红蛋白降低(1.81 ±0.93)g/L,红细胞压积下降1.24% ±0.43%,血钠下降(1.14±0.35)mmol/L.患者术后平均住院时间(3.1±1.1)d,拔管平均时间为(2.3±0.8)d.患者随访时间6 ~ 131个月,平均32.4个月.患者术后国际前列腺症状评分进行性下降;术后生活质量评分(2.2±1.7)较术前(5.7±3.3)降低(t=2.447,P<0.01),随访时进一步下降,与术后比较差异有统计学意义(t=2.179、2.228、2.306、2.365,P<0.05);术后最大尿流率亦有改善(P<0.05).患者术后并发症包括膀胱颈挛缩(4例)、尿路感染(107例)、尿道狭窄(11例)及尿失禁(11例),11例患者再次手术.结论 HoLEP治疗前列腺增生症能达到与开放手术相同的效果,同时具有损伤小、恢复快、并发症少等优点,是一种良好的治疗选择.

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abstracts:

Objective To evaluate the safety,effectiveness,and outcomes of holmium laser enucleation of the prostate(HoLEP)for patients with symptomatic enlarged prostate after 11 years of experience.Methods The 3162 evaluable patients treated with holmium laser enucleation of the prostate at our institution between August 2001 and August 2011 were retrospectively analyzed.Study variables included International Prostate Symptom Score,quality of life,maximum urinary flow rate,and incidence of complications.Results HoLEP were performed successfully completed,not patients which occurs as electric cutting syndrome.The operation time was(60.8 ± 18.4)minutes;average resection of prostate quality was (45.4 ±24.4)g.The hemoglobin reduce though surgery was(1.81 ±0.93)g/L;percentage of red blood cell change was 1.24% ± 0.43%,and sodium blood drop was(1.14 ± 0.35)mmol/L.Postoperative patients of hospital stay(3.1 ± 1.1)days,average time of indwelling catheter time was(2.3 ± 0.8)days.Patients were followed up for 6-131 months time,an average of 32.4 months.Postoperative patients with international prostate symptom score progressive declined.The quality of life score was 2.2 ± 1.7,and it less than preoperative(5.7 ± 3.3,t =2.447,P < 0.01).The time of follow-up droped further,and postoperative comparative differences have statistical significance(t =2.179,2.228,2.306 and 2.365,P < 0.05).The maximum urinary flow rate also improved(P < 0.05).Postoperative complications included bladder neck contracture(4 cases),urinary tract infection(107 cases),urethral stricture(11 cases)and urinary incontinence(11 cases).The 11 patients reoperation.Conclusions HoLEP treatment of benign prostatic hyperplasia could achieve the advantages of open surgery the same effect.It had fewer damage,faster recovery,fewer complications,and is a good treatment option.

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