郴州市第一人民医院 泌尿外科一区，湖南 郴州 423000
Department of Urology, the First People’s Hospital of Chenzhou, Chenzhou, Hunan 423000, China
目的 探讨高龄高危前列腺增生患者行保留尿控策略的1470 nm激光剜除术的手术技巧。方法 回顾性分析2020年1月－2021年3月该院收治的70例高龄高危前列腺增生患者的临床资料。其中，35例患者采用保护尿控功能的改良1470 nm激光前列腺剜除术作为保留尿控组，以同期35例采用常规1470 nm激光剜除术的患者作为对照组。比较两组患者术后拔除导尿管后各时点压力性尿失禁的发生率，分析治疗效果及安全性。结果 所有患者术后5 d拔除导尿管。拔除尿管后24 h，保留尿控组与对照组压力性尿失禁发生率分别为5.7%和31.4%，差异有统计学意义（P < 0.05），拔除尿管后1周分别为2.9%和20.0%（P > 0.05），拔除尿管后1个月，分别为0.0%和8.6%（P > 0.05）；术后3个月，两组患者压力性尿失禁发生率均为0.0%，两组间压力性尿失禁发生率在拔除导尿管1周后差异无统计学意义。术后随访3个月，两组患者最大尿流率（Qmax）、国际前列腺症状评分（I-PSS）和生活质量评分（QOL）均较术前明显改善，差异有统计学意义（P < 0.05）。结论 采用基于尿控的改良1470 nm激光前列腺剜除术，术后压力性尿失禁发生率低，疗效显著，是一种适合高龄高危前列腺增生患者的安全、有效的手术方式。
Objective To explore the effect of continence-preserving technique and strategy in transurethral 1470 nm laser enucleation for advanced age and high-risk patients with benign prostatic hyperplasia.Methods We retrospectively analyzed 70 high risk patients of advanced age with prostate enlargement from January 2020 to March 2021, 35 of whom were treated with modified 1470 nm laser prostate enucleation to protect urinary control function as the reserved urinary control group. At the same time, 35 patients with conventional 1470 nm laser enucleation in the same period were used as the control group. The incidence of stress urinary incontinence at each time point after catheter removal was compared between the two groups, and then the efficacy and safety were analyzed and evaluated.Results All the patients had their catheters removed 5 d after surgery, and the incidence of stress urinary incontinence were 5.7% and 31.4% 24 h after catheter removal in the reserved urinary control group and the control group, respectively, with statistically significant differences between the two groups (P < 0.05), 2.9% and 20.0% 1 week after catheter removal (P > 0.05), and 0.0% and 8.6% 1 month after catheter removal (P > 0.05), and at 3 months after surgery, the incidence of urinary incontinence was 0.0% in both groups, the difference between the two groups was not statistically significant 1 week after catheter removal. The maximum urinary flow rate (Qmax), international prostate symptom score (I-PSS) and quality of life score (QOL) were significantly improved in both groups at 3 months after surgery compared with the preoperative period, and the differences were statistically significant (P < 0.05).Conclusion Modified 1470 nm laser enucleation of prostate based on continence-preserving technique has a low incidence of stress urinary incontinence and a significant efficacy, making it a safe and effective procedure for elderly patients with prostatic hyperplasia.