“露天隧道法”經(jīng)尿道前列腺超脈沖光纖銩激光剜除術(shù)與鈥激光剜除術(shù)治療良性前列腺增生的臨床效果比較

Comparison of the clinical efficacy of super pulse thulium laser enucleation of the prostate with “open tunnel” and holmium laser enucleation of the prostate for benign prostatic hyperplasia

XU Jidong，JIANG Ning，LI Jian，CAI Zhikang，LYU Jianwei，HU Chuanyi，ZHENG Jingcun，CAI Zhonglin，CHEN Huiying，GU Yan，WANG Yuning，YAN Jiasheng，WANG Zhong

［Department of Urology，Shanghai Pudong Gongli Hospital （Gongli Hospital of Naval Medical University），Shanghai 200135，China］

ABSTRACT：Objective To compare the clinical efficacy of super pulse thulium laser enucleation of the prostate （SPThuLEP） with “open tunnel” and transurethral holmium laser enucleation of the prostate （HoLEP） in the treatment of benign prostatic hyperplasia （BPH），in order to provide reference for the treatment options of BPH.Methods The clinical data of 112 BPH patients treated in our hospital during Jan.2023 and Jul.2023 were retrospectively analyzed，including 65 treated with SPThuLEP with “open tunnel” and 57 with HoLEP.The operation time，postoperative hemoglobin decrease，postoperative bladder irrigation，catheter indwelling time，hospitalization time and complications were compared between the two groups.The changes of maximum urine flow rate （Qmax），international prostate symptom score （IPSS），quality of life score （QoL），postvoid residual （PVR） and prostate-specific antigen （PSA） were compared between the two groups before operation and one month after operation.Results All operations were successful without conversion to open or transurethral plasmakinetic resection.The postoperative decrease of hemoglobin in SPThuLEP group was lower than that in HoLEP group [（13.12±6.72） g/L vs. （21.02±6.51） g/L]，with statistical difference （Plt;0.05）.There were no significant differences in the operation time [（63.35±15.73） min vs.（61.02±17.55） min]，postoperative bladder irrigation time [（1.07±0.45） d vs. （1.06±0.36） d]，catheter indwelling time [（2.98±0.56） d vs. （3.01±0.63） d] and hospitalization time [（3.63±0.61） d vs.（3.79±0.76） d] between the two groups （Pgt;0.05）.No blood transfusion，secondary bleeding or unplanned hospitalization occurred，and there were no serious complications such as transurethral electroresection syndrome （TURS），urethral stricture and urinary incontinence.One month after operation，the Qmax，IPSS，QoL，PVR and PSA of the two groups were significantly improved compared with those before operation （Plt;0.05），but with no statistical difference between the two groups （Pgt;0.05）.Conclusion SPThuLEP with “open tunnel” has comparable efficacy as HoLEP in the treatment of BPH.With advantages of small amount of bleeding and high safety，this minimally invasive technique can be widely popularized in clinical practice.

KEY WORDS：super pulse thulium laser; holmium laser; benign prostatic hyperplasia; enucleation of the prostate;HYPERLINK\"http：//211.136.105.155/s/net/cnki/kns/G.https/kcms/detail/knetsearch.aspx？dbcode=CJFDamp;sfield=kwamp;skey=photovaporization%20of%20the%20prostateamp;code=amp;uid=WEEvREcwSlJHSldSdmVqelcxVTI2Nk8zQ0VRWnZzQWJlYk0xbjBMTGM3WT0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw！！\"＼t\"/Users/mrx/Documentsx/_blank\" “open tunnel method”

摘要：目的 對(duì)比“露天隧道法”經(jīng)尿道前列腺超脈沖光纖銩激光剜除術(shù)（SPThuLEP）與經(jīng)尿道前列腺鈥激光剜除術(shù)（HoLEP）治療良性前列腺增生（BPH）的臨床效果，以期為BPH治療方案的選擇提供參考。方法 回顧性分析2023年1—7月于上海市浦東新區(qū)

公利醫(yī)院接受經(jīng)尿道激光手術(shù)治療的112例BPH患者的臨床資料，其中65例采用“露天隧道法”SPThuLEP治療 （SPThuLEP組），57例采用HoLEP治療（HoLEP組）。比較兩組患者的手術(shù)時(shí)間、術(shù)后血紅蛋白下降量、術(shù)后膀胱沖洗時(shí)間、留置導(dǎo)尿管時(shí)間、住院時(shí)間及并發(fā)癥發(fā)生情況。比較兩組患者術(shù)前及術(shù)后1個(gè)月最大尿流率（Qmax）、國(guó)際前列腺癥狀評(píng)分（IPSS）、生活質(zhì)量評(píng)分（QoL）、膀胱殘余尿量（PVR）、前列腺特異性抗原（PSA）水平。結(jié)果 所有患者均順利完成手術(shù)，無中轉(zhuǎn)開放或經(jīng)尿道等離子電切術(shù)。SPThuLEP組患者術(shù)后血紅蛋白下降量低于HoLEP組[（13.12±6.72）g/L vs.（21.02±6.51）g/L]，差異有統(tǒng)計(jì)學(xué)意義（Plt;0.05）。SPThuLEP組和HoLEP組患者的平均手術(shù)時(shí)間[（63.35±15.73）min vs.（61.02±17.55）min]、術(shù)后膀胱沖洗時(shí)間[（1.07±0.45）d vs.（1.06±0.36）d]、留置導(dǎo)尿管時(shí)間[（2.98±0.56）d vs.（3.01±0.63）d]及住院時(shí)間[（3.63±0.61）d vs.（3.79±0.76）d]比較，差異均無統(tǒng)計(jì)學(xué)意義（Pgt;0.05）。所有患者均未輸血，均無二次出血、非計(jì)劃二次住院、電切綜合征（TURS）、尿道狹窄、尿失禁等嚴(yán)重并發(fā)癥。術(shù)后1個(gè)月兩組患者的Qmax、IPSS、QoL、PVR及PSA水平均較術(shù)前明顯改善（Plt;0.05），但兩組間上述指標(biāo)差異均無統(tǒng)計(jì)學(xué)意義（Pgt;0.05）。結(jié)論 采用“露天隧道法”SPThuLEP治療BPH的臨床療效與HoLEP相當(dāng)，但該微創(chuàng)手術(shù)的術(shù)中及術(shù)后出血量更少且安全性高，值得在臨床廣泛推廣。

關(guān)鍵詞：超脈沖光纖銩激光；鈥激光；良性前列腺增生；剜除術(shù)；“露天隧道法”

中圖分類號(hào)：R692"" 文獻(xiàn)標(biāo)志碼：A

DOI：10.3969/j.issn.1009-8291.2025.01.007

良性前列腺增生（benign prostatic hyperplasia，BPH）是泌尿外科常見疾病，男性50歲以上的發(fā)病率gt;50%，80歲以上高達(dá)83%^[1]，部分BPH患者因藥物療效欠佳或存在并發(fā)癥需行外科治療^[2]。……