绿激光剜除术和经尿道电切术治疗大体积前列腺增生症的前瞻性随机对照研究

严滴石; 刘正超; 郑俊; 蒋涛; 陈志朋; 王永权; 周晓洲; 周远秀; 周占松; 沈文浩

doi:10.16016/j.1000-5404.202009030

您当前的位置：

首页 >

文章列表页 >

绿激光剜除术和经尿道电切术治疗大体积前列腺增生症的前瞻性随机对照研究

临床医学 | 更新时间：2026-01-09

- 绿激光剜除术和经尿道电切术治疗大体积前列腺增生症的前瞻性随机对照研究
- Photoselective enucleation of prostate versus tranuretheral resection of the prostate for large-size benign prostatic hyperplasia: a randomized prospective controlled study
- 第三军医大学学报 2021年43卷第3期页码：255-260
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院全军泌尿外科研究所
- 作者简介：
  
  [沈文浩，E-mail：chongqingswh@aliyun.com SHEN Wenhao, E-mail: chongqingswh@aliyun.com
- 基金信息：
  
  重庆技术创新与应用示范(社会民生类)一般项目(CSTC2018jscx-mxybx0190);陆军军医大学第一附属医院重大领域技术创新计划项目(SWH2016ZDCX2008)
- DOI：10.16016/j.1000-5404.202009030
  中图分类号： R181.32;R697.32;R699.8
- 收稿：2020-09-05，
  
  修回：2020-10-29，
  
  纸质出版：2021-02-15
- 稿件说明：
移动端阅览
严滴石, 刘正超, 郑俊, 等. 绿激光剜除术和经尿道电切术治疗大体积前列腺增生症的前瞻性随机对照研究[J]. 第三军医大学学报, 2021,43(3):255-260.

Dishi YAN, Zhengchao LIU, Jun ZHENG, et al. Photoselective enucleation of prostate versus tranuretheral resection of the prostate for large-size benign prostatic hyperplasia: a randomized prospective controlled study[J]. Journal of Third Military Medical University, 2021, 43(3): 255-260.
严滴石, 刘正超, 郑俊, 等. 绿激光剜除术和经尿道电切术治疗大体积前列腺增生症的前瞻性随机对照研究[J]. 第三军医大学学报, 2021,43(3):255-260. DOI： 10.16016/j.1000-5404.202009030.

Dishi YAN, Zhengchao LIU, Jun ZHENG, et al. Photoselective enucleation of prostate versus tranuretheral resection of the prostate for large-size benign prostatic hyperplasia: a randomized prospective controlled study[J]. Journal of Third Military Medical University, 2021, 43(3): 255-260. DOI： 10.16016/j.1000-5404.202009030.

摘要

目的

对比研究经尿道绿激光直出光纤前列腺锐性剜除术(photoselective sharp-enucleation of prostate with end-firing fibre，PSEP)与经尿道前列腺电切术(transurethral resection of prostate

TURP)治疗大体积良性前列腺增生症(benign prostatic hyperplasia，BPH)患者的安全性和有效性。

方法

根据本研究的纳入和排除标准，选取2018年7月至2019年12月在本院诊治并且前列腺体积(prostate volume，PV)＞80 mL的BPH患者，采用随机数字表法分成两组，每组47例，分别行TURP(TURP组)和PSEP(PSEP组)，收集两组患者的一般情况和围手术期资料，记录并比较术后1、6个月的最大尿流率(maximum urine flow rate，Qmax)、国际前列腺症状评分(international prostate symptom score，IPSS)、残余尿(post-void residual urine，PVR)、生活质量评分(quality of life score，Qols)、国际尿失禁咨询委员会尿失禁问卷表简表(international consultation on incontinence questionnaire-urinary incontinence-short form，ICI-Q-SF评分)、前列腺特异抗原(prostate-specific antigen，PSA)、PV以及相关并发症等。

结果

术后6个月，PSEP组和TURP组分别有43例和44例完成随访。两组术前一般情况差异无统计学意义，术后1、6个月两组Qmax、IPSS、Qols、PVR、PSA及ICI-Q-SF评分较术前均有明显改善。PSEP组比TURP组有更短的手术时间、膀胱冲洗时间、留置尿管时间、住院时间和更少的血红蛋白下降量。术后6个月PSEP组PV明显小于TURP组。两组术后并发症发生率差异无统计学意义。

结论

PSEP与TURP治疗大体积BPH疗效肯定，具有良好的安全性。与TURP相比，PSEP具有手术效率高、出血量少、组织去除更彻底、术后恢复快的优点，是治疗大体积BPH患者的更优选择。

Abstract

Objective

To compare the efficacy and safety of photoselective sharp-enucleation of prostate with end-firing fibre (PSEP) and tranuretheral resection of the prostate (TURP) in the treatment of large-size benign prostatic hyperplasia (BPH).

Methods

According to the inclusion and exclusion criteria of the study

totally 94 BPH patients with prostate volume (PV) >80 mL admitted in our hospital from July 2018 to December 2019 were prospectively enrolled

and then randomized into TURP and PSEP group

with 47 cases in each group. Preoperative and perioperative data were collected

and maximum flow rate (Qmax)

international prostate symptom score (IPSS)

post-void residual urine (PVR)

quality of life score (Qols)

score of international consultation on incontinence questionnaire-urinary incontinence-short form (ICI-Q-SF)

prostate-specific antigen (PSA) level

PV and related complications in 1 and 6 months after surgery were recorded and compared between the 2 groups.

Results

There were 43 and 44 patients completing the followed-up in PSEP and TURP groups respectively in 6 month postoperatively. No significant differences were found in baseline data between the 2 groups

and Qmax

PVR

PSA level

and scores of IPSS

Qols and ICI-Q-SF were significantly improved at 1 and 6 months after surgery in both groups. The operation time (71.6±21.2

87.6±18.9 min

0.01)

bladder irrigation time (7.1±5.7

19.8 ±8.6 h

0.01)

catheterization period (3.4±1.7

4.4±1.6 d

0.01)

and length of hospital stay (4.3±1.0

5.2±1.3 d

0.01) were significantly shorter in the PSEP group than those in the TURP group. The former group also had remarkably milder haemoglobin dropping (5.5±3.2

12.2±6.6 g/L

0.01)

and more obviously smal

ler PV (21.3±4.0

25.2±6.1 mL

0.01) in 6 months when compared with the latter group. What's more

there was no statistical difference in the incidence of postoperative complications between them.

Conclusion

Both PSEP and TURP show good efficacy and safety in the treatment of large-size BPH. Compared with TURP

PSEP has the advantages of high surgical efficiency

less bleeding

more thorough tissue removal

and faster postoperative recovery. It is an optional choice for the patients with large-size BPH.

关键词

Keywords

references

GRATZKE C, BACHMANN A, DESCAZEAUD A, et al . EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction[J ] . Eur Urol, 2015, 67(6):1099-1109. DOI:10.1016/j.eururo.2014.12.038.

CAO N L, LU Q J, SI J M, et al . The characteristics of the transitional zone in prostate growth with age[J ] . Urology, 2017, 105: 136-140. DOI:10.1016/j.urology.2017.03.010.

ZHANG S J, QIAN H N, ZHAO Y, et al . Relationship between age and prostate size[J ] . Asian J Androl, 2013, 15(1): 116-120. DOI:10.1038/aja.2012.127.

MISRAÏ V, PASQUIE M, BORDIER B, et al . Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience[J ] . World J Urol, 2018, 36(5): 793-799. DOI:10.1007/s00345-018-2192-z.

RIEKEN M, GRATZKE C. Have we really abandoned open simple prostatectomy today?[J]. Eur Urol, 2014, 66(2): 292-293. DOI:10.1016/j.eururo.2014.04.026.

赵力, 沈文浩, 印苏培, 等.经尿道前列腺电切术治疗大体积良性前列腺增生安全性及有效性的回顾性对照研究[J].中华泌尿外科杂志, 2015, 36(4): 299-303. DOI:10.3760/cma.j.issn.1000-6702.2015.04.014.

ZHAO L, SHEN W H, YIN S P, et al . Retrospective study of the safety and effectiveness of transurethral resection of the prostate for benigh prostatic hyperplasia in large prostates[J ] . Chin J Urol, 2015, 36(4 ): 299-303. DOI:10.3760/cma.j.issn.1000-6702.2015.04.014.

MESKAWI M, HUEBER P A, VALDIVIESO R, et al . Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc)[J ] . World J Urol, 2017, 35(10): 1603-1609. DOI:10.1007/s00345-017-2007-7.

刘正超, 蒋涛, 陈志朋, 等.绿激光直出式剜除和选择性汽化治疗良性前列腺增生症患者的随机对照研究[J].第三军医大学学报, 2020, 42 (5): 511-516. DOI: 10.16016/j.1000-5404.201911198.

LIU Z C, JIANG T, CHEN Z P, et al . Green light top-firing sharp enucleation of prostate versus photoselective vaporisation of prostate for benign prostatic hyperplasia: a randomized controlled trial[J ] . J Third Mil Med Univ. 2020, 42 (5): 511-516. DOI: 10.16016/j.1000-5404.201911198.

王建业, 宋希双, 杜传军, 等.良性前列腺增生诊断治疗指南[M]//那彦群, 叶章群, 孙颖浩.中国泌尿外科疾病诊断治疗指南手册.北京: 人民卫生出版社, 2014: 259-261.

WANG J Y, SONG X S, DU C J, et al . Guidelines for the diagnosis and treatment of benign prostatic hyperplasia [M ] //NA Y Q, YE Z Q, SUN Y H, et al . Guidelines for diagnosis and treatment of Chinese urological diseases. Beijing: People's Medical Publishing House, 2014: 259-261..

REICH O, GRATZKE C, BACHMANN A, et al . Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10, 654 patients[J ] . J Urol, 2008, 180(1): 246-249. DOI:10.1016/j.juro.2008.03.058.

YUCEL M, ARAS B, YALCINKAYA S, et al . Original Paper Conventional monopolar transurethral resection of prostate in patients with large prostate (≥80 grams)[J ] . Central Eur J Urol, 2013, 66(3): 303-308. DOI:10.5173/ceju.2013.03.art13.

AL-HAMMOURI F, ABU-QAMAR A. Monopolar transurethral resection of the big prostate, experience at Prince Hussein Bin Abdullah Urology Center[J]. J Pak Med Assoc, 2011, 61(7): 628-631.

GOMEZ SANCHA F, RIVERA V C, GEORGIEV G, et al . Common trend: move to enucleation: Is there a case for GreenLight enucleation? Development and description of the technique[J ] . World J Urol, 2015, 33(4): 539-547. DOI:10.1007/s00345-014-1339-9.

ELSHAL A M, ELKOUSHY M A, EL-NAHAS A R, et al . GreenLight TM laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study[J ] . J Urol, 2015, 193(3): 927-934. DOI:10.1016/j.juro.2014.09.097..

EKEN A, SOYUPAK B. Safety and efficacy of photoselective vaporization of the prostate using the 180-W GreenLight XPS laser system in patients taking oral anticoagulants[J]. J Int Med Res, 2018, 46(3): 1230-1237. DOI:10.1177/0300060517747489.

HABIB E, AYMAN L M, ELSHEEMY M S, et al . Holmium laser enucleation vs bipolar plasmakinetic enucleation of a large volume benign prostatic hyperplasia: a randomized controlled trial[J ] . J Endourol, 2020, 34(3): 330-338. DOI:10.1089/end.2019.0707..

文爽, 杨林, 罗军, 等.经尿道前列腺绿激光剜除术与前列腺电切术治疗前列腺增生症效果对比分析[J].第三军医大学学报, 2020, 42(8):1868-1874. DOI:10.16016/j.1000-5404.202004032.

WEN S, YANG L, LUO J, et al . Comparative analysis of green laser enucleation of prostate and transurethral resection of the prostate in the treatment of benign prostatic hyperplasia[J ] . J Third Mil Med Univ, 2020, 42(8):1868-1874. DOI:10.16016/j.1000-5404.202004032.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

绿激光直出式剜除和选择性汽化治疗良性前列腺增生症患者的随机对照研究

经尿道前列腺绿激光剜除术与前列腺电切术治疗前列腺增生症效果对比分析

经尿道激光与电切术治疗非肌层浸润性膀胱癌效果及安全性比较的Meta分析

皮秒脉冲固体激光对乳猪皮肤组织的气化效应

经前列腺小囊射精管切开术治疗23例顽固性血精症临床分析