over-night模式下日间经尿道钬激光前列腺剜除术的围手术期安全性与可行性研究

Perioperative safety and feasibility assessment of day-case transurethral holmium laser enucleation of prostate under over-night mode

摘要:

目的 评估over-night模式下日间经尿道钬激光前列腺剜除术（HoLEP）的围手术期安全性与可行性。方法 回顾性分析2021年1月－2023年3月该院83例良性前列腺增生（BPH）患者的临床资料，由同一术者完成HoLEP治疗。根据围手术期管理方法不同分为over-night日间HoLEP组（over-night组，43例）和普通HoLEP组（普通组，40例），根据前列腺体积分为大体积组（≥ 50 mL）与小体积组（ < 50 mL）。记录所有患者的年龄和围手术期资料［前列腺总体积、前列腺切除重量、切除标本比例、手术时间、外周静脉血血红蛋白（Hb）变化、膀胱冲洗时间、带尿管时间和首次拔管成功率等］，并对各组间的参数进行比较。结果 83例患者均未出现HoLEP相关的再次手术和再入院情况；over-night组中，年龄57～90岁，平均（70.1±7.3）岁，前列腺体积29～161 mL，平均（63.0±28.8）mL，全部顺利完成流程，均在24 h内办理出院，无中转普通组病例，首次拔管成功率为88.4%（38/43），平均带管时间（17.8±3.6）h；普通组中，年龄55～87岁，平均（70.4±8.2）岁，前列腺体积22～118 mL，平均（59.4±29.0）mL，平均带管时间（77.5±25.1）h，首次拔管成功率为90.0%（36/40）；两组患者前列腺总体积、前列腺切除重量、切除标本比例、手术时长、外周静脉血Hb变化、膀胱冲洗时间和首次拔管成功率比较，差异均无统计学意义（P > 0.05），带尿管时间比较，差异有统计学意义（P < 0.01）。结论 无论前列腺体积大小，日间HoLEP均是安全和可行的；over-night模式下的日间HoLEP，适合在国内广泛开展，尤其在HoLEP手术经验丰富的医疗中心，可常规开展。

Abstract:

Objective To evaluate the perioperative safety and feasibility of day-case transurethral holmium laser enucleation of prostate (HoLEP) under over-night mode.Method From January 2021 to March 2023, 83 patients of benign prostatic hyperplasia (BPH) were elected and treated with HoLEP by the one surgeon. According to different management methods, these patients were divided into the over-night day-case HoLEP group and the ordinary HoLEP group. Again, these patients were divided into large volume (≥ 50 mL) group and small volume ( < 50 mL) group according to the prostate volume. Record the age and perioperative data of all patients [total prostate volume, prostate resection weight, proportion of prostate resection, operating time, changes in peripheral venous blood hemoglobin (Hb), bladder flushing duration, catheter insertion duration, and success rate of first tube removal], the parameters of each group were compared.Result All of the 83 patients undergoing HoLEP surgery in this study, and there were no cases of HoLEP related reoperation or readmission. Among them, there were 43 cases in the over-night HoLEP group, aged 57~90 with an average of (70.1 ± 7.3) years old, and the prostate volume was 29~161 mL with an average of (63.0 ± 28.8) mL, All of them were discharged within 24 h, and there were no cases transferred to the ordinary HoLEP group, the success rate of first tube removal was 88.4% (38/43), and with average catheterization duration was (17.8 ± 3.6) h; The other 40 cases were included into the ordinary HoLEP group, aged 55 ~ 87 with an average of (70.4 ± 8.2) years old, the volume of the prostate was 22 ~ 118 mL with an average of (59.4 ± 29.0) mL, the success rate of first tube removal was 90.0% (36/40), and with average catheterization duration was (77.5 ± 25.1) h; There was no statistically significant difference in the perioperative parameters (total prostate volume, prostate resection weight, proportion of prostate resection, operating time, changes in peripheral venous blood Hb, and bladder flushing time) between the two groups (P > 0.05), while the difference in catheter duration was statistically significant (P < 0.01).Conclusion Regardless of the size of the prostate volume, day-case HoLEP is safe and feasible. Day-case HoLEP under the over-night mode is suitable for widespread and routine implementation in China, especially in medical centers with rich experience of HoLEP.