El-Hakim A, Elhilali M M
Department of Urology, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
BJU Int. 2002 Dec;90(9):863-9. doi: 10.1046/j.1464-410x.2002.03071.x.
To present the initial experience of a senior urology resident with holmium laser enucleation of the prostate (HoLEP) and to address the difficulties encountered while learning this technique, describing the detailed operative technique and pitfalls.
Between July and August 2001, 27 patients were treated using HoLEP administered by one senior urology resident (A.H.) under the supervision of an experienced urologist (M.M.E.). Patients were assessed before and 1 month after HoLEP by the International Prostate Symptom Score (IPSS), the associated quality-of-life (QoL) score, and measurements of maximum urinary flow rate (Qmax) and postvoid residual urine (PVR) volume. The prostate volume was measured before HoLEP using transrectal ultrasonography. The 27 patients were compared retrospectively with 118 who underwent HoLEP by the supervising urologist. Each of the 27 procedures was taped and reviewed.
The mean (range) prostate size was 54.8 (21-122) mL (A.H.) and 61.7 (20.5-172) mL (M.M.E.). The mean operative duration was 98 (50-175) min and the mean enucleation time 68 (29-108) min. The improvements in IPSS, QoL score, Qmax and PVR were highly significant (P < 0.001), with mean values before and after HoLEP of 16.8 and 8.2, 3.1 and 1.4, 7.7 and 20.8 mL/s, and 232 and 41.3 mL, respectively. Of the 27 patients, 23 (85%) were catheter-free on the first day after HoLEP; the mean hospital stay was 1.8 days. All these results were comparable with the results of 118 patients treated by M.M.E. The two most difficult technical steps identified were the initial apical enucleation and the incision of the remaining antero-apical mucosal attachment of the lateral lobes. The operator became adept with the HoLEP technique after a mean of 20 patients.
HoLEP can be learnt but requires longer training than standard transurethral resection. Extensive experience with transurethral surgery and the supervision of an experienced urologist are prerequisites for success.
介绍一名泌尿外科高级住院医师开展钬激光前列腺剜除术（HoLEP）的初步经验，并阐述学习该技术过程中遇到的困难，详细描述手术操作技巧及陷阱。
2001年7月至8月期间，27例患者在一名经验丰富的泌尿外科医生（M.M.E.）监督下，由一名泌尿外科高级住院医师（A.H.）实施HoLEP治疗。在HoLEP术前及术后1个月，采用国际前列腺症状评分（IPSS）、相关生活质量（QoL）评分、最大尿流率（Qmax）测量及残余尿量（PVR）测量对患者进行评估。术前通过经直肠超声测量前列腺体积。将这27例患者与118例由该监督泌尿外科医生实施HoLEP治疗的患者进行回顾性比较。对这27例手术均进行录像并回顾分析。
平均（范围）前列腺大小，A.H.组为54.8（21 - 122）mL，M.M.E.组为61.7（20.5 - 172）mL。平均手术时间为98（50 - 175）分钟，平均剜除时间为68（29 - 108）分钟。IPSS、QoL评分、Qmax及PVR的改善非常显著（P < 0.001），HoLEP术前及术后的平均值分别为16.8和8.2、3.1和1.4、7.7和20.8 mL/s以及232和41.3 mL。27例患者中，23例（85%）在HoLEP术后第一天即可拔除导尿管；平均住院时间为1.8天。所有这些结果与M.M.E.治疗的118例患者的结果相当。确定的两个最困难的技术步骤是最初的尖部剜除以及外侧叶剩余前尖部黏膜附着处的切开。平均经过20例患者的操作后，术者熟练掌握了HoLEP技术。
HoLEP可以学会，但与标准经尿道切除术相比需要更长时间的培训。丰富的经尿道手术经验及经验丰富的泌尿外科医生的监督是成功的前提条件。
