远端尿道黏膜环切断在经尿道钬激光前列腺剜除手术治疗良性前列腺增生中的应用

Application of distal urethral mucosal loop transection in treatment of BPH by HoLEP

摘要:

目的 评价360°尿道黏膜预切断改良经尿道钬激光前列腺剜除术（HoLEP）治疗良性前列腺增生（BPH）的安全性和有效性。方法 回顾性分析2018年6月－2020年2月于海南省中医院泌尿外科就诊的89例行360°尿道黏膜预切断改良HoLEP手术治疗的BPH患者的临床资料。记录患者术前、术中及术后随访的临床资料，分析及评估改良HoLEP手术的疗效及安全性。结果 89例手术均成功，手术时间45～170 min，切除腺体重量30～180 g，留置尿管3～6 d，平均（3.5±1.5）d，术后血红蛋白浓度为（125.3±21.5）g/L，术后3个月时国际前列腺症状评分（IPSS）为（8.2±2.2）分，最大尿流率（Qmax）（22.9±5.1）mL/s，剩余尿量（PVR）（36.7±12.8）mL。改良术后有78例患者可达成即时控尿，7例患者在48 h内也能达到控尿，日常生活不用带尿不湿。2例（2.2%）患者短暂性压力性尿失禁3个月；1例（1.1%）拔尿管后4个月短暂性压力性尿失禁，1例（1.1%）拔尿管后8个月短暂性压力性尿失禁，无术后永久性尿失禁。术后3个月复查，随访期间有1例尿道外口狭窄，1例膀胱颈挛缩，予以手术处理。结论 360°尿道黏膜预切断改良HoLEP手术治疗BPH安全有效，术后尿失禁发生率低，值得推广。

Abstract:

Objective To evaluate the safety and effectiveness of the modified HoLEP operation in treatment of benign prostatic hyperplasia with 360°pre-cuturethral mucosal.Methods Clinical data of 89 patients with benign prostatic hyperplasia underwent the modified HoLEP operation in treatment of benign prostatic hyperplasia with 360°pre-cuturethral mucosal from June 2018 to February 2020 was retrospectively analyzed. The clinical data of patients was recorded, then analyze and evaluate the efficacy and safety of the modified HoLEP.Results All the 89 cases were successfully operated. The operation time was 45～170 minutes and the mass of the removed glands was 30～180 g. The catheter was left for 3～6 days, with an average of (3.5 ± 1.5) days. The postoperative hemoglobin concentration was (125.3 ± 21.5) g/L. Three months after the operation, the IPSS was (8.2 ± 2.2), the maximum urine flow rate was (22.9 ± 5.1) mL/s, and the remaining urine volume was (36.7 ± 12.8) mL. 78 cases after the modified operation can achieve immediate urinary control, and 7 cases can also achieve urinary control within 48 hours and do not need diapers in daily life. 2 cases (2.2%) had transient stress urinary incontinence for 3 months; 1 case (1.1%) had transient stress urinary incontinence 4 months after catheter removal, 1 case (1.1%) had transient stress urinary incontinence 8 months after catheter removal. There was no permanent urinary incontinence after the operation. During the 3-month follow-up, 1 case of external urethral stenosis and 1 case of bladder neck contracture were treated surgically.Conclusion The modified HoLEP operation for the treatment of benign prostatic hyperplasia with 360°pre-cut urethral mucosa is safe and effective, and the incidence of postoperative urinary incontinence is low, which is worthy of promotion.