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目的:比较应用激光操作架和应用镜鞘行经尿道前列腺铥激光剜除术治疗良性前列腺增生(BPH)的效果和安全性。方法:回顾性分析上海市东方医院2020年1—6月收治的128例BPH患者的临床资料。128例均行经尿道前列腺铥激光剜除术(THuLEP)，其中66例采用激光操作架直视推拨法剜除前列腺(LC-THuLEP组)，62例应用镜鞘钝性撬拨剜除前列腺(THuLEP组)。LC-THuLEP组和THuLEP组的年龄分别为(71.00±8.72)岁和(70.32±7.80)岁，前列腺体积分别为(74.80±40.88)ml和(73.14±36.31)ml，前列腺特异性抗原(PSA)分别为(4.67±4.99)ng/ml和(4.89±4.59)ng/ml，国际前列腺症状评分(IPSS)分别为(19.48±5.30)分和(18.50±5.05)分，生活质量(QOL)评分分别为(4.17 ± 0.78)分和(4.18± 0.67)分，最大尿流率(Qn max)分别为(9.82± 2.58)ml/s和(9.98± 2.91)ml/s，残余尿量(PVR)分别为(60.20±39.19)ml和(61.11±52.83)ml，国际勃起功能问卷评分(IIEF-5)分别为(5.58±4.50)分和(5.60±4.16)分，差异均无统计学意义(n P>0.05)。LC-THuLEP组在精阜前方0.5 cm处Ω形切开前列腺尿道黏膜，显露前列腺包膜后，回退光纤至激光操作架内，应用激光操作架于前列腺增生腺体和前列腺外科包膜层面直视下推拨腺体，并沿包膜层面扩展，如遇到出血点或前列腺粘连索带则伸出光纤予凝固或激光切断，最终将前列腺整体剜除。比较两组的手术时间、手术前后血红蛋白下降值、剜除组织重量、术后膀胱冲洗时间、留置导尿管时间，以及两组术后1、3、6个月的IPSS、QOL评分、Qn max、PVR，术后6个月的IIEF-5评分、并发症。n 结果:LC-THuLEP组和THuLEP组的手术时间分别为(71.85±25.68)min和(80.65±29.64)min，术后血红蛋白下降值分别为(6.42±9.89)g/L和(9.47±10.79)g/L，剜除组织重量分别为(56.73±31.21)g和(48.11±24.50)g，术后膀胱持续冲洗时间分别为(14.73±2.71)h和(16.06±2.71)h，术后留置尿管时间分别为(4.41±1.92)d和(4.31±1.66)d，差异无统计学意义(n P>0.05)。LC-THuLEP组术后1、3、6个月的IPSS分别为(6.52±2.46)分、(5.83±2.43)分、(5.30±2.49)分，QOL评分分别为(2.36±0.85)分、(2.27±1.02)分、(1.98±0.77)分，Qn max分别为(22.89±2.41)ml/s、(23.61±2.62)ml/s、(23.83±3.53)ml/s。THuLEP组术后1、3、6个月的IPSS分别为(7.60±1.89)分、(6.86±1.81)分、(6.44±1.78)分，QOL评分分别为(2.68±0.67)分、(2.74±1.01)分、(2.35±0.68)分，Qn max分别为(21.31±2.52)ml/s、(22.13±2.51)ml/s、(22.11±2.49)ml/s。除术后6个月Qn max外，两组其他指标比较差异均有统计学意义(n P0.05)。所有手术均未发生膀胱损伤，无严重出血，无术后出血需要输血或二次手术病例。LC-THuLEP组和THuLEP组术后1个月尿失禁发生率分别为6.1%(4/66)和19.4%(12/62)，差异有统计学意义(n P＝0.023)，术后3个月[4.5%(3/66)与6.5%(4/62)]及6个月[1.5%(1/66)与(2/62，3.2%)]差异均无统计学意义(n P>0.05)。附睾炎[3.0%(2/66)与1.6%(1/62)]、尿道狭窄[1.5%(1/66)与3.2%(2/62)]、膀胱颈挛缩[1.5%(1/66)与3.2%(2/62)]发生率两组间差异无统计学意义(n P>0.05)。n 结论:在前列腺铥激光剜除术中应用激光操作架直视推拨，与应用镜鞘钝性撬拨相比，疗效更好，并发症发生率更低，是一种安全、有效的手术方法。“,”Objective:To compare the efficacy and safety of transurethral thulium laser enucleation of prostate for benign prostatic hyperplasia (BPH) with laser controller and sheath.Methods:The clinical data of 128 BPH patients who underwent transurethral thulium laser enucleation of prostate (THuLEP) in our hospital from January to June 2020 were retrospectively analyzed. Prostatic enucleation by laser controller was performed in 66 patients (LC-THuLEP group). The prostatic urethral mucosa was cut into Ω shape at 0.5 cm in front of the verumontanum to expose the prostate capsule, and then the fiber was retracted into the laser controller. Push the gland directly between the prostate gland and the prostate surgical capsule and expand along the capsule by the laser controller. In case of bleeding or prostate adhesive cord, the fiber was extended to coagulate or cut off, and the prostate was eventually en bloc removed. THuLEP by sheath was performed in 62 cases (THuLEP group). The ages of patients in LC-THuLEP group and THuLEP group were (71.00±8.72) years and (70.32±7.80) years, respectively. The prostate volumes were (74.80±40.88) ml and (73.14±36.31) ml, respectively. Prostate specific antigen (PSA) was (4.67±4.99) ng/ml and (4.89±4.59) ng/ml, International Prostate Symptom Score (IPSS) was (19.48±5.30) points and (18.50±5.05) points, respectively. The quality of life (QOL) scores were (4.17 ± 0.78) points and (4.18± 0.67) points, the maximum urine flow rate (Q n max) was (9.82± 2.58) ml /s and (9.98± 2.91) ml/s, respectively. Postvoid residual (PVR) was (60.20±39.19) ml and (61.11±52.83) ml, respectively. The international index of erectile function (IIEF-5) score was (5.58±4.50) and (5.60±4.16), respectively.There was no significant difference in preoperative baseline data between 2 groups (n P>0.05). The operation time, the reduced level of hemoglobin, the weight of removed tissue, The time to postoperative bladder irrigation, the time to indwelling catheter and complications were compared between the two groups. IPSS, QOL score, Qn max, PVR, and complications were compared between the two groups at 1, 3 and 6 months after surgery, while IIEF-5 score were compared only at 6 months after surgery.n Results:The operative time of LC-THuLEP group and THuLEP group was (71.85±25.68) min and (80.65±29.64) min, respectively, and the decrease of postoperative hemoglobin was (6.42±9.89) g/L and (9.47±10.79) g/L, respectively, the weight of the removed tissue was (56.73±31.21) g and (48.11±24.50) g, respectively, and the time to postoperative bladder irrigation was (14.73±2.71) h and (16.06±2.71) h, respectively, the time to indwelling catheter was (4.41±1.92)d and (4.31±1.66)d, respectively, with no statistically significant differences between the two groups. IPSS scores of LC-THuLEP group were (6.52±2.46) points, (5.83±2.43) points and (5.30±2.49) points at 1, 3 and 6 months after surgery, respectively. QOL scores were (2.36±0.85) points, (2.27±1.02) points and (1.98±0.77) points, Qn max were (22.89±2.41) ml/s, (23.61±2.62) ml/s and (23.83±3.53) ml/s, respectively. In THuLEP group, IPSS were (7.60±1.89) points, (6.86±1.81) points and (6.44±1.78) points at 1, 3 and 6 months after surgery, and QOL scores were (2.68±0.67) points, (2.74±1.01) points and (2.35±0.68) points, respectively. Qn max were (21.31±2.52) ml/s, (22.13±2.51) ml/s and (22.11±2.49) ml/s, respectively. Those indexes (except Qmax at 6 months)were better in LC-ThuLEP group than THuLEP group, and the differences were statistically significant (n P0.05).n Conclusion:Compared by sheath, THuLEP by laser controller could be a safe and effective surgical method with better curative effect and lower complication rate.