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良性前列腺增生(benign prostatic hyperplasia,BPH)是引起中老年男性排尿障碍的常见病因[1],临床上主要表现为膀胱出口梗阻和下尿路症状。由于我国社会老龄化的逐步加剧,经济水平的提高,其发病率、就诊率呈逐年升高趋势。对于口服药物治疗效果不佳的病人,积极手术治疗是最有效的措施,经尿道前列腺电切术(transurethral resection of the prostate,TURP)是治疗BPH的金标准[2],但有些病人合并心脑血管疾病,长期口服抗凝剂治疗基础疾病,采用TURP术需提前停用抗凝剂,提高了围手术期的风险。近年随着钬激光技术在医疗领域的广泛应用以及经自然腔道手术理念的深入,经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)已成为治疗BPH的重要治疗手段[3]。HoLEP的治疗效果相当于开放手术及TURP,其在外科包膜层面剜除增生腺体,因此具有出血少、切除组织多等优势。本研究观察HoLEP治疗长期口服抗凝剂BPH病人的疗效及安全性。现作报道。
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所有病人均顺利完成手术,无术中术后输血、包膜穿孔、电切综合征等并发症。观察组手术时间长于对照组(P < 0.05),2组术后血红蛋白下降量、冲洗时间和留置导尿管时间差异均无统计学意义(P>0.05)。术后随访3个月,随访期间未出现二次出血、再入院、排尿困难、尿失禁等并发症。2组术后3个月Qmax、PVR、IPSS评分、QoL评分差异均无统计学意义(P>0.05)(见表 1)。
分组 n 手术时间/min 血红蛋白下降量/(g/L) 冲洗时间/d 留置导尿管时间/d Qmax/(mL/s) PVR/mL IPSS评分/分 QoL评分/分 观察组 100 55.81±12.35 5.87±3.27 1.21±0.45 3.19±0.48 16.04±1.84 7.51±5.33 5.00±1.97 1.78±0.91 对照组 105 51.89±10.54 5.83±3.19 1.16±0.39 3.15±0.38 16.16±1.41 7.33±5.08 4.84±1.80 1.82±1.03 t — 2.45 0.09 0.85 0.66 0.53 0.24 0.61 0.29 P — < 0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 表 1 2组病人围手术期指标和随访资料比较(x±s)
HoLEP在长期口服抗凝剂前列腺增生病人中的应用
Clinical study on the application of HoLEP in prostatic hyperplasia patients with long-term oral anticoagulants
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摘要:
目的分析经尿道钬激光前列腺剜除术(HoLEP)治疗长期口服抗凝剂前列腺增生病人的有效性及安全性。 方法回顾性分析205例前列腺增生病人临床资料,将100例口服抗凝剂病人作为观察组,105例未口服抗凝剂病人作为对照组。比较2组病人手术时间、血红蛋白下降量、冲洗时间及留置导尿时间。术后随访3个月,比较2组术后最大尿流率、残余尿量、国际前列腺症状评分、生活质量评分。 结果所有病人均顺利完成手术,无术中术后输血、包膜穿孔、电切综合征等并发症。观察组手术时间长于对照组(P < 0.05),2组术后血红蛋白下降量、冲洗时间和留置导尿管时间差异均无统计学意义(P>0.05)。2组术后3个月最大尿流率、残余尿量、国际前列腺症状评分、生活质量评分差异均无统计学意义(P>0.05)。 结论HoLEP治疗长期口服抗凝剂前列腺增生病人安全有效,值得临床推广。 Abstract:ObjectiveTo analyze the efficacy and safety of transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of prostatic hyperplasia patients with long-term oral anticoagulants. MethodsThe clinical data of 205 patients with prostatic hyperplasia were retrospectively analyzed.One hundred patients with oral anticoagulants were set as the observation group, and 105 patients without oral anticoagulants were set as the control group.The operation time, hemoglobin decrease amount, washing time and indwelling catheter time were compared between the two groups.The patients were followed up for 3 months, and the maximum urine flow rate, residual urine volume, international prostate symptom score, and quality of life score after operation were compared between the two groups. ResultsThe operation in all the patients was successfully completed, and there were no complications such as intraoperative and postoperative blood transfusion, capsule perforation, and electrotomy syndrome.The operation time in the observation group was longer than that in the control group (P < 0.05), and there were no significant differences in the hemoglobin decrease amount, washing time and indwelling catheter time between the two groups after operation (P>0.05).There were no significant differences in the maximum urine flow rate, residual urine volume, international prostate symptom score and quality of life score between the two groups at 3 months after operation(P>0.05). ConclusionsHoLEP is safe and effective in the treatment of prostatic hyperplasia patients with long-term oral anticoagulants, and is worthy of clinical promotion. -
Key words:
- prostatic hyperplasia /
- holmium laser /
- anticoagulant
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表 1 2组病人围手术期指标和随访资料比较(x±s)
分组 n 手术时间/min 血红蛋白下降量/(g/L) 冲洗时间/d 留置导尿管时间/d Qmax/(mL/s) PVR/mL IPSS评分/分 QoL评分/分 观察组 100 55.81±12.35 5.87±3.27 1.21±0.45 3.19±0.48 16.04±1.84 7.51±5.33 5.00±1.97 1.78±0.91 对照组 105 51.89±10.54 5.83±3.19 1.16±0.39 3.15±0.38 16.16±1.41 7.33±5.08 4.84±1.80 1.82±1.03 t — 2.45 0.09 0.85 0.66 0.53 0.24 0.61 0.29 P — < 0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 -
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