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目的探讨经尿道选择性绿激光前列腺汽化术(greenlight photoselective vaporization of prostate,PVP)与经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗近期及远期疗效。方法随机选取行PVP和TURP的良性前列腺增生(benign prostatic hyperplasia,BPH)患者各80例,比较2组术前与术后1年及5年最大尿流率、IPSS评分、膀胱残余尿量的变化情况,比较术后近期、远期并发症的发生率。结果 PVP组术后1年最大尿流率、IPSS评分、残余尿量由(5.2±1.6)mL/s、(19.6±2.4)分、(87.2±10.1)mL改善为(14.7±2.5)mL/s、(4.6±1.2)分、(18.3±2.6)mL。TURP组术后1年最大尿流率、IPSS评分、残余尿量由(4.9±1.3)mL/s、(20.2±1.8)分、(85.4±9.6)mL改善为(15.2±1.9)mL/s、(5.1±1.3)分、(16.1±1.8)mL。2组排尿状况各指标的改善情况差异无显著性(P>0.05)。PVP组出血(3.75%vs8.75%)、尿失禁(1.25%vs 5.00%)的发生率低于TURP组(P<0.05)。术后5年PVP组最大尿流率、IPSS评分、残余尿量分别为(10.2±2.3)mL/s、(12.7±2.3)分、(38.5±10.2)mL,TURP组分别为(13.7±1.5)mL/s、(5.5±1.7)分、(10.5±1.6)mL,排尿状况各指标的改善情况优于PVP组(P<0.05)。术后2～5年PVP组出血(17.5%vs 3.75%)、急性尿潴留(12.5%vs 6.25%)发生率高于TURP组,尿失禁发生率(1.25%vs 5.00%)低于TURP组(P<0.05)。结论 PVP与TURP治疗BPH近期疗效相似,PVP并发症发生率更低,TURP远期疗效优于PVP,TURP远期并发症发生率更低,PVP术不能替代TURP术,应针对不同情况选择不同手术方式。
Objective To investigate the short-term and long-term effects of transurethral resection of prostate (TURP) treated with greenlight photoselective vaporization of prostate (PVP). Methods Eighty patients with benign prostatic hyperplasia (BPH) were randomly selected. The changes of the maximum urinary flow rate, the IPSS score and the residual urinary bladder volume were compared between the two groups before and one year and five years after operation. Situation, compare the incidence of postoperative short-term and long-term complications. Results The maximum urinary flow rate, IPSS score and residual urine volume in PVP group were improved from (5.2 ± 1.6) mL / s, (19.6 ± 2.4) and (87.2 ± 10.1) mL to (14.7 ± 2.5) mL / s, (4.6 ± 1.2) min, (18.3 ± 2.6) mL. The maximum urinary flow rate, IPSS score and residual urine volume in TURP group were improved from (4.9 ± 1.3) mL / s, (20.2 ± 1.8) and (85.4 ± 9.6) mL to (15.2 ± 1.9) mL / s , (5.1 ± 1.3) points, (16.1 ± 1.8) mL. There was no significant difference in the improvement of each index between the two groups (P> 0.05). The incidence of hemorrhage (3.75% vs8.75%) and urinary incontinence (1.25% vs 5.00%) in PVP group was lower than that in TURP group (P <0.05). The maximum urinary flow rate, IPSS score and residual urine volume of PVP group were (10.2 ± 2.3) mL / s, (12.7 ± 2.3) and (38.5 ± 10.2) mL respectively at 5 years after operation and were 13.7 ± 1.5 ), mL (5.5 ± 1.7), (10.5 ± 1.6) mL. The improvement of urination status was better than PVP group (P <0.05). The incidence of hemorrhage (17.5% vs 3.75%), acute urinary retention (12.5% vs 6.25%) in PVP group 2 to 5 years after operation was significantly higher than that in TURP group (1.25% vs 5.00%, P < P <0.05). Conclusions PVP and TURP have similar effects in the treatment of BPH. The incidence of PVP is lower, the long-term efficacy of TURP is better than that of PVP. The long-term complication rate of TURP is lower. PVP can not replace TURP. Different surgical procedures should be selected according to different circumstances the way.