经尿道980 nm DiLEP与TUPKP治疗良性前列腺增生的疗效及术后储尿期症状改善的影响因素

Efficacy of transurethral 980 nm DiLEP and TUPKP in the treatment of benign prostatic hyperplasia

摘要:

目的 探讨经尿道980 nm红激光前列腺剜除术（DiLEP）与等离子双极前列腺切除术（TUPKP）对良性前列腺增生（BPH）患者的疗效，以及术后储尿期症状改善的影响因素。方法 回顾性分析青海省人民医院2018年6月—2019年9月收治的行经尿道980 nm DiLEP 274例患者和行TUPKP 152例患者的临床资料，分别作为研究组和对照组。比较两组疗效，术后血红蛋白（Hb）、残余尿量、手术相关指标、并发症发生情况，以及国际前列腺症状评分（IPSS）、生活质量评分（QOL）、膀胱过度活动症评分（OABSS）。并采用单因素分析及非条件一般多因素Logistic回归分析影响患者术后储尿期症状改善的独立影响因素。结果 研究组手术时间、术中冲洗液总量、导尿管留置时间及住院时间均短于对照组，术中冲洗液总量少于对照组（P <0.05）。研究组术后发生膀胱痉挛、急迫性尿失禁等并发症的风险低于对照组（P <0.05）。术后随访6个月，研究组IPSS评分及残余尿量低或少于对照组（P <0.05），QOL、OABSS评分高于对照组（P <0.05）。单因素分析结果表明，年龄、残余尿量、夜尿次数、逼尿肌收缩力及手术方法是患者术后储尿期症状改善的影响因素（P <0.05）；一般多因素Logistic回归分析结果显示，年龄［O^R=0.131（95% CI：0.065，0.261）］、逼尿肌收缩力［O^R=10.612（95% CI：6.565，17.153）］、夜尿次数［O^R=0.520（95% CI：0.405，0.668）］、残余尿量［O^R=0.255（95% CI：0.167，0.387）］、手术方法［O^R=0.086（95% CI：0.056，0.130）］是患者术后储尿期症状改善的独立影响因素（P <0.05）。结论 经尿道980 nm DiLEP相比传统的TUPKP临床效果更佳，术中出血量少且手术和住院时间短，并发症发生风险低，是治疗BPH的有效手段。年龄、残余尿量、夜尿次数、逼尿肌收缩力均是BPH患者术后储尿期症状改善的独立影响因素，术前应高度重视。

Abstract:

Objective To explore the therapeutic effects of transurethral 980 nm diode laser enucleation of the prostate (DiLEP) and bipolar transurethral plasma kinetic prostatectomy (TUPKP) for benign prostatic hyperplasia (BPH), and the factors affecting the improvement of postoperative urinary storage symptoms.Methods The data of 274 patients undergoing 980 nm DiLEP (study group) and 152 patients undergoing TUPKP (control group) admitted to Qinghai Provincial People's Hospital from June 2018 to September 2019 were analyzed retrospectively. The therapeutic effect, the postoperative hemoglobin (Hb) content, residual urine volume, surgery-related indicators, complications, the International Prostate Symptom Score (IPSS), the Quality of Life (QOL) score and the Overactive Bladder Symptom Score (OABSS) were compared between the two groups. Univariate analysis and unconditional multivariate Logistic regression analysis were performed to determine the independent factors influencing the improvement of postoperative urinary storage symptoms.Results The total amount of intraoperative irrigating fluid was lower, and the operative duration, the duration of indwelling urinary catheter and the length of hospital stay were shorter in the study group compared with the control group (P < 0.05). The risk of complications such as the bladder spasm and the urgency incontinence in the study group was lower than that in the control group (P < 0.05). After 6 months, the IPSS and the residual urine volume in the study group were lower than those in the control group (P < 0.05), while the QOL score and OABSS in the study group were higher than those in the control group (P < 0.05). The univariate analysis showed that the age, residual urine volume, frequency of nocturia, detrusor contractility and surgical methods influenced the improvement of postoperative urinary storage symptoms (P < 0.05). Multivariate Logistic regression analysis showed that age [O^R = 0.131 (95% CI: 0.065, 0.261)], detrusor contractility [O^R = 10.612 (95% CI: 6.565, 17.153)], frequency of nocturia [O^R = 0.520 (95% CI: 0.405, 0.668)], residual urine volume [O^R = 0.255 (95% CI: 0.167, 0.387)], and surgical methods [O^R = 0.086 (95% CI: 0.056, 0.130)] were independent factors affecting the improvement of postoperative urinary storage symptoms (P < 0.05).Conclusions The clinical effect of transurethral 980 nm DiLEP is better than that of TUPKP for the treatment of BPH, with less intraoperative bleeding, a shorter duration of operation, a shorter length of hospital stay, and a lower risk of complications. In addition, age, residual urine volume, frequency of nocturia, and detrusor contractility are all independent factors that affect the improvement of postoperative urinary storage symptoms in BPH patients, and should be highly valued before operation.