[钬激光剜除术治疗良性前列腺增生症的并发症]

[Complications of the holmium laser enucleation of prostate for benign prostatic hyperplasia].

作者信息

Davydov D S, Tsarichenko D G, Bezrukov E A, Sukhanov R B, Vinarov A Z, Sorokin N I, Enikeev D V, Dymov A M, Danilov S P

机构信息

Research Institute for Uronephrology and Human Reproductive Health, Department of Urology, R.M. Fronshteyn Urology Clinic, I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia.

出版信息

Urologiia. 2018 Mar(1):42-47.

PMID:29634133

Abstract

INTRODUCTION

With growing experience in the HoLEP, it can replace TURP as the "gold standard" for the surgical management of BPH, and therefore this technique is the most studied surgical modality. Despite the proven effectiveness of HoLEP in the treatment of patients with BPH, its widespread use has been associated with both intra- and postoperative complications.

AIM

To improve the results of surgical management of patients with BPH.

MATERIAL AND METHODS

The study comprised 310 patients who underwent HoLEP for BPH. HoLEP was performed using the Gillings technique.

INCLUSION CRITERIA

presence of LUTS (Qmax<15 ml/s, Qav<10 ml/s, presence of residual urine, I-PSS score> 5, QoL score> 2), absence of an active inflammatory process of the urogenital organs.

RESULTS

Intraoperative complications included severe hemorrhage in 16 (5.2%), the bladder wall injury in 17 (5.5%) and the ureteral orifice injury in 2 (0.6%) patients. 275 (88.7%) had no intraoperative complications. Early postoperative complications included fever in 4 (1.3%), the bladder tamponade that required cystoscopy and evacuation of blood clots in 7 (2.3%) and acute urinary retention in 36 (11.8%) patients. 263 (84.6%) patients had no postoperative complications. Long-term postoperative complications comprised urinary incontinence in 39 (12.6%) patients and urethral strictures requiring surgical treatment in 9 (2.9%) patients. There were no long-term complications in 262 (84.5%) patients.

CONCLUSION

HoLEP is an effective and safe surgical modality for treating patients with BPH with minimal complications, suitable for any size of the prostate.

摘要

引言

随着经尿道前列腺激光剜除术（HoLEP）经验的不断积累，它可取代经尿道前列腺电切术（TURP）成为良性前列腺增生（BPH）手术治疗的“金标准”，因此该技术是研究最多的手术方式。尽管HoLEP治疗BPH患者的有效性已得到证实，但其广泛应用仍伴随着术中及术后并发症。

目的

提高BPH患者的手术治疗效果。

材料与方法

本研究纳入310例行HoLEP治疗BPH的患者。采用吉利斯技术进行HoLEP手术。

纳入标准

存在下尿路症状（最大尿流率<15 ml/s，平均尿流率<10 ml/s，存在残余尿，国际前列腺症状评分>5，生活质量评分>2），泌尿生殖器官无活动性炎症。

结果

术中并发症包括16例（5.2%）严重出血、17例（5.5%）膀胱壁损伤和2例（0.6%）输尿管口损伤。275例（88.7%）无术中并发症。术后早期并发症包括4例（1.3%）发热、7例（2.3%）需要膀胱镜检查及清除血凝块的膀胱填塞和36例（11.8%）急性尿潴留。263例（84.6%）患者无术后并发症。术后长期并发症包括39例（12.6%）患者尿失禁和9例（2.9%）患者需要手术治疗的尿道狭窄。262例（84.5%）患者无长期并发症。