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Article(id=1198558111649858518, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558106218230069, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0864.2023.1130, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1687190400000, receivedDateStr=2023-06-20, revisedDate=null, revisedDateStr=null, acceptedDate=1692720000000, acceptedDateStr=2023-08-23, onlineDate=1763688121950, onlineDateStr=2025-11-21, pubDate=1727452800000, pubDateStr=2024-09-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763688121950, onlineIssueDateStr=2025-11-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763688121950, creator=13701087609, updateTime=1763688121950, updator=13701087609, issue=Issue{id=1198558106218230069, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='9', pageStart='977', pageEnd='1098', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763688120655, creator=13701087609, updateTime=1763689155065, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198562444915339352, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558106218230069, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198562444915339353, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558106218230069, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=992, endPage=997, ext={EN=ArticleExt(id=1198558111901516766, articleId=1198558111649858518, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Data analysis of perioperative period in 2050 cases of benign prostatic hyperplasia surgery in a single center over 10 years, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To summarize and analyze the surgical evolution and clinical efficacy of benign prostatic hyperplasia (BPH) surgery. Methods A retrospective cohort study was used to analyze the clinical data of 2050 patients who underwent surgery for BPH in the Department of Urology, the First Medical Center of PLA General Hospital from January 2012 to August 2022. These patients were divided into 3 groups in chronological order: the early group (n=683), the middle group (n=683) and the late group (n=684). The cumulative time of patients in each group was from January 2012 to February 2017, March 2017 to September 2020 and October 2020 to August 2022. The indicators, such as age, hypertension, diabetes, serum cholesterol, serum triacylglycerol, serum high-density lipoprotein cholesterol, body mass index (BMI), preoperative prostate volume, prostate specific antigen (PSA), free prostate specific antigen (fPSA), operation time, preoperative hospital stay, postoperative hospital stay, postoperative bladder flushing time, postoperative indwelling time, cystostomy situation, intraoperative and postoperative blood transfusion, postoperative readmission rate, and postoperative pathology were collected and compared between 3 groups, and the annual trend of changes in the number of BPH surgeries and surgical methods was analyzed. Results Transurethral resection of prostate (TURP) and TURP+laser resection decreased year by year, while transurethral laser resection of prostate increased and became the mainstream prostate resection method in recent two years, accounting for more than 90%. The patients in the early, middle and late groups were (69.7±7.9) years old, (68.7±7.4) years old and (69.8±8.5) years old (P=0.027); the operation time was 108.0(80.0, 130.0) min, 80.0(60.0, 110.0) min and 75.0 (60.0, 100.0) min (P<0.001); the postoperative indwelling time was 4.1(2.7, 5.9) d, 3.9(2.9, 4.9) d and 2.7(0.9, 3.9) d (P<0.001); the rates of cystostomy were 68.8%, 66.6% and 5.0% (P<0.001); the intraoperative and postoperative blood transfusion rates were 4.5%, 3.1% and 0.9% (P<0.001); the preoperative hospitalization time was 5.6(3.8, 7.1) d, 4.7(3.5, 5.9) d, and 4.7(3.1, 6.7) d (P<0.001); the postoperative hospital stays were 5.7(4.8, 7.0) d, 4.7(3.0, 5.9) d and 2.8(1.0, 4.0) d (P<0.001), with statistically significant differences. Thirty-seven cases (1.8%) of BPH patients who underwent surgery in our center for 10 years were re-admitted after surgery, and 64 cases had postoperative pathological abnormalities or were diagnosed with prostate cancer, with a total detection rate of 3.1%. Conclusions Laser enucleation of prostate has become the mainstream surgical treatment of BPH in our center, and perioperative indexes such as operation time, hospital stay, postoperative catheter indwelling time, cystostomy rate, and surgical blood transfusion rate have shown a significant improvement trend.

, correspAuthors=Qing Yuan, authorNote=null, correspAuthorsNote=
E-mail:
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目的 总结分析良性前列腺增生(BPH)手术术式的变化及临床疗效。方法 回顾性分析2012年1月-2022年8月于解放军总医院第一医学中心泌尿外科接受BPH手术治疗的2050例患者的临床资料。按时间顺序将患者分为前期组(n=683)、中期组(n=683)、后期组(n=684)，各组患者累计时间分别为2012年1月-2017年2月、2017年3月-2020年9月及2020年10月-2022年8月。收集并比较各组患者年龄、高血压、糖尿病、血清胆固醇、血清三酰甘油、血清高密度脂蛋白胆固醇、体重指数(BMI)、术前前列腺体积、前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)、手术时间、术前住院时间、术后住院时间、术后膀胱冲洗时间、术后尿管留置时间、膀胱造瘘情况、术中和术后输血情况、术后再入院率、术后病理等指标。分析BPH手术量及手术方式的逐年变化趋势。结果 经尿道前列腺电切术(TURP)及TURP+激光术式逐年减少，而经尿道前列腺激光剜除术占比不断增高，并在近两年成为主流术式；前期组、中期组、后期组患者年龄分别为(69.7±7.9)岁、(68.7±7.4)岁和(69.8±8.5)岁(P=0.027)；手术时间分别为108.0(80.0，130.0) min、80.0(60.0，110.0) min和75.0(60.0，100.0) min (P<0.001)；术后尿管留置时间分别为4.1(2.7，5.9) d、3.9(2.9，4.9) d和2.7(0.9，3.9) d(P<0.001)；膀胱造瘘率分别为68.8%、66.6%和5.0%(P<0.001)；术中及术后输血率分别为4.5%、3.1%、0.9%(P<0.001)；术前住院时间分别为5.6(3.8，7.1) d、4.7(3.5，5.9) d和4.7(3.1，6.7) d(P<0.001)；术后住院时间分别为5.7(4.8，7.0) d、4.7(3.0，5.9) d和2.8(1.0，4.0) d (P<0.001)，差异均有统计学意义。本中心10年BPH手术患者术后再次入院37例(1.8%)，术后病理异常或病理确诊为前列腺癌64例，总检出率为3.1%。结论 前列腺激光剜除术已成为本中心BPH外科治疗的主流术式，手术时间、住院时间、术后尿管留置时间、膀胱造瘘率、手术输血率等围手术期相关指标均呈现明显改善的趋势。

, correspAuthors=袁清, authorNote=null, correspAuthorsNote=
袁清，E-mail：
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杨国荣，硕士研究生，主要从事泌尿外科前列腺疾病及下尿路战创伤方面的研究

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杨国荣，硕士研究生，主要从事泌尿外科前列腺疾病及下尿路战创伤方面的研究

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杨国荣，硕士研究生，主要从事泌尿外科前列腺疾病及下尿路战创伤方面的研究

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Aging Male, 2017, 20(3): 184-191., articleTitle=Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis, refAbstract=null), Reference(id=1198558122429219333, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2021, volume=36, issue=6, pageStart=431, pageEnd=438, url=null, language=null, rfNumber=[21], rfOrder=20, authorNames=陈佳炜, 海波, 董伟, journalName=临床泌尿外科杂志, refType=null, unstructuredReference=陈佳炜, 海波, 董伟, 等. 钬激光前列腺剜除术和经尿道前列腺电切术治疗BPH疗效和安全性的Meta分析[J]. 临床泌尿外科杂志, 2021, 36(6): 431-438., articleTitle=钬激光前列腺剜除术和经尿道前列腺电切术治疗BPH疗效和安全性的Meta分析, refAbstract=null), Reference(id=1198558122534076940, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2022, volume=43, issue=6, pageStart=595, pageEnd=598, 603, url=null, language=null, rfNumber=[22], rfOrder=21, authorNames=杜丽娜, 张武合, 杨发, journalName=空军军医大学学报, refType=null, unstructuredReference=杜丽娜, 张武合, 杨发, 等. BPH患者经尿道前列腺钬激光剜除术与经尿道前列腺电切术的临床疗效比较研究[J]. 空军军医大学学报, 2022, 43(6): 595-598, 603., articleTitle=BPH患者经尿道前列腺钬激光剜除术与经尿道前列腺电切术的临床疗效比较研究, refAbstract=null), Reference(id=1198558122643128844, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2021, volume=24, issue=1, pageStart=160, pageEnd=170, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=Li J, Cao D, Huang Y, journalName=Aging Male, refType=null, unstructuredReference=Li J, Cao D, Huang Y, et al. Holmium laser enucleation versus bipolar transurethral enucleation for treating benign prostatic hyperplasia, which one is better?[J]. Aging Male, 2021, 24(1): 160-170., articleTitle=Holmium laser enucleation versus bipolar transurethral enucleation for treating benign prostatic hyperplasia, which one is better?, refAbstract=null), Reference(id=1198558122727014930, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2019, volume=26, issue=null, pageStart=13, pageEnd=19, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=Das AK, Teplitsky S, Humphreys MR, journalName=Can J Urol, refType=null, unstructuredReference=Das AK, Teplitsky S, Humphreys MR. Holmium laser enucleation of the prostate (HoLEP): a review and update[J]. Can J Urol, 2019, 26(4 ): 13-19., articleTitle=Holmium laser enucleation of the prostate (HoLEP): a review and update, refAbstract=Suppl 1), Reference(id=1198558122819289621, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2022, volume=17, issue=null, pageStart=15, pageEnd=33, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=Yilmaz M, Esser J, Suarez-Ibarrola R, journalName=Clin Interv Aging, refType=null, unstructuredReference=Yilmaz M, Esser J, Suarez-Ibarrola R, et al. Safety and efficacy of laser enucleation of the prostate in elderly patients - a narrative review[J]. Clin Interv Aging, 2022, 17: 15-33., articleTitle=Safety and efficacy of laser enucleation of the prostate in elderly patients - a narrative review, refAbstract=null), Reference(id=1198558122945118746, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2020, volume=27, issue=S3, pageStart=44, pageEnd=50, url=null, language=null, rfNumber=[26], rfOrder=25, authorNames=Das AK, Han TM, Hardacker TJ, journalName=Can J Urol, refType=null, unstructuredReference=Das AK, Han TM, Hardacker TJ. Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia[J]. Can J Urol, 2020, 27(S3): 44-50., articleTitle=Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia, refAbstract=null), Reference(id=1198558123054170656, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2020, volume=79, issue=null, pageStart=217, pageEnd=221, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=He G, Sun C, Shu Y, journalName=Int J Surg, refType=null, unstructuredReference=He G, Sun C, Shu Y, et al. The diagnostic value of prostate cancer between holmium laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia: A retrospective comparative study[J]. Int J Surg, 2020, 79: 217-221., articleTitle=The diagnostic value of prostate cancer between holmium laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia: A retrospective comparative study, refAbstract=null), Reference(id=1198558124140495396, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, doi=null, pmid=null, pmcid=null, year=2021, volume=127, issue=2, pageStart=238, pageEnd=246, url=null, language=null, rfNumber=[28], rfOrder=27, authorNames=Shamout S, Carlson K, Brotherhood HL, journalName=BJU Int, refType=null, unstructuredReference=Shamout S, Carlson K, Brotherhood HL, et al. Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: a population-based cohort study[J]. BJU Int, 2021, 127(2): 238-246., articleTitle=Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: a population-based cohort study, refAbstract=null)], funds=[Fund(id=1198558119941996925, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, awardId=2021YFC2009304, language=EN, fundingSource=National Key Research and Development Program of China(2021YFC2009304), fundOrder=null, country=null), Fund(id=1198558120072020356, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, awardId=2021YFC2009304, language=CN, fundingSource=国家重点研发计划(2021YFC2009304), fundOrder=null, country=null), Fund(id=1198558120155906444, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, awardId=20220484230, language=EN, fundingSource=Beijing NOVA Program(20220484230), fundOrder=null, country=null), Fund(id=1198558120285929873, 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tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, language=EN, label=Tab.1, caption=

Basic information of patients undergoing benign prostatic hyperplasia (BPH) surgery at this center from January 2012 to August 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
项目前期组(n=683)中期组(n=683)后期组(n=684)F/χ2/HP
年龄(岁, $\bar{x}±s$)69.7±7.968.7±7.469.8±8.53.6080.027
民族[例(%)]1.4100.494
汉族660(96.6)652(95.5)654(95.6)
其他23(3.4)31(4.5)30(4.4)
地域[例(%)]162.026<0.001
本地246(36.0)224(32.8)437(63.9)
外地437(64.0)459(67.2)247(36.1)
费别[例(%)]596.612<0.001
地方公疗50(7.3)32(4.7)2(0.3)
地方医保111(16.3)94(13.8)171(25.0)
军队医改24(3.5)10(1.5)102(14.9)
异地医保0194(28.4)251(36.7)
全费498(72.9)353(51.7)158(23.1)
吸烟[例(%)]313(45.0)424(62.1)318(46.5)46.270<0.001
饮酒[例(%)]339(50.0)500(73.2)293(42.8)140.397<0.001
高血压[例(%)]209(30.6)209(30.6)310(45.3)33.640<0.001
糖尿病[例(%)]65(9.5)87(12.7)138(20.2)43.469<0.001
血清胆固醇[mmol/L, M(Q1, Q3)]4.0(3.5, 4.7)4.1(3.5, 4.6)4.0(3.4, 4.6)1.9840.378
血清三酰甘油[mmol/L, M(Q1, Q3)]1.0(0.8, 1.4)1.1(0.8,1.5)1.1(0.8, 1.5)6.3130.053
血清高密度脂蛋白胆固醇[mmol/L, M(Q1, Q3)]1.1(0.9, 1.3)1.1(0.9, 1.3)1.1(1.0, 1.3)1.9460.378
BMI[kg/m², M(Q1, Q3)]24.4(22.3, 26.4)24.3(22.4, 26.4)24.4(22.4, 26.4)0.2000.905
BMI[kg/m², 例(%)]0.8170.093
<18.516(2.3)20(2.9)18(2.6)
18.5~23.9288(42.2)283(41.4)277(41.4)
≥24.0379(55.5)380(55.6)389(56.0)
术前前列腺体积[cm³, M(Q1, Q3)]61.6(44.2, 88.6)67.2(44.2, 92.7)58.7(41.3, 84.1)3.8130.149
术前前列腺特异性抗原[ng/ml, M(Q1, Q3)]
PSA4.4(2.2, 9.1)4.7(2.3,8.6)4.0(1.8, 7.8)4.9810.083
fPSA0.9(0.4, 1.7)0.9(0.4, 1.6)0.8(0.4, 1.5)1.0230.600
), ArticleFig(id=1198558118490767716, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, language=CN, label=表1, caption=

本中心2012年1月-2022年8月良性前列腺增生(BPH)手术治疗患者的基本资料

, figureFileSmall=null, figureFileBig=null, tableContent=
项目前期组(n=683)中期组(n=683)后期组(n=684)F/χ2/HP
年龄(岁, $\bar{x}±s$)69.7±7.968.7±7.469.8±8.53.6080.027
民族[例(%)]1.4100.494
汉族660(96.6)652(95.5)654(95.6)
其他23(3.4)31(4.5)30(4.4)
地域[例(%)]162.026<0.001
本地246(36.0)224(32.8)437(63.9)
外地437(64.0)459(67.2)247(36.1)
费别[例(%)]596.612<0.001
地方公疗50(7.3)32(4.7)2(0.3)
地方医保111(16.3)94(13.8)171(25.0)
军队医改24(3.5)10(1.5)102(14.9)
异地医保0194(28.4)251(36.7)
全费498(72.9)353(51.7)158(23.1)
吸烟[例(%)]313(45.0)424(62.1)318(46.5)46.270<0.001
饮酒[例(%)]339(50.0)500(73.2)293(42.8)140.397<0.001
高血压[例(%)]209(30.6)209(30.6)310(45.3)33.640<0.001
糖尿病[例(%)]65(9.5)87(12.7)138(20.2)43.469<0.001
血清胆固醇[mmol/L, M(Q1, Q3)]4.0(3.5, 4.7)4.1(3.5, 4.6)4.0(3.4, 4.6)1.9840.378
血清三酰甘油[mmol/L, M(Q1, Q3)]1.0(0.8, 1.4)1.1(0.8,1.5)1.1(0.8, 1.5)6.3130.053
血清高密度脂蛋白胆固醇[mmol/L, M(Q1, Q3)]1.1(0.9, 1.3)1.1(0.9, 1.3)1.1(1.0, 1.3)1.9460.378
BMI[kg/m², M(Q1, Q3)]24.4(22.3, 26.4)24.3(22.4, 26.4)24.4(22.4, 26.4)0.2000.905
BMI[kg/m², 例(%)]0.8170.093
<18.516(2.3)20(2.9)18(2.6)
18.5~23.9288(42.2)283(41.4)277(41.4)
≥24.0379(55.5)380(55.6)389(56.0)
术前前列腺体积[cm³, M(Q1, Q3)]61.6(44.2, 88.6)67.2(44.2, 92.7)58.7(41.3, 84.1)3.8130.149
术前前列腺特异性抗原[ng/ml, M(Q1, Q3)]
PSA4.4(2.2, 9.1)4.7(2.3,8.6)4.0(1.8, 7.8)4.9810.083
fPSA0.9(0.4, 1.7)0.9(0.4, 1.6)0.8(0.4, 1.5)1.0230.600
), ArticleFig(id=1198558119648395625, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, language=EN, label=Tab.2, caption=

Surgical outcomes of patients with benign prostatic hyperplasia (BPH) undergoing surgery at our center from January 2012 to August 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
指标前期组(n=683)中期组(n=683)后期组(n=684)F/H/χ2P
手术时间[min, M(Q1, Q3)]108.0(80.0, 130.0)80.0(60.0, 110.0)75.0(60.0, 100.0)194.353<0.001
术后膀胱冲洗时间[d, M(Q1, Q3)]1.9(1.2, 2.9)1.9(1.3, 2.9)1.7(0.8, 2.7)0.7160.699
术后尿管留置时间[d, M(Q1, Q3)]4.1(2.7, 5.9)3.9(2.9, 4.9)2.7(0.9, 3.9)167.597<0.001
膀胱造瘘时间[d, M(Q1, Q3)]3.9(2.9, 5.3)2.9(2.5, 3.9)3.6(2.1, 4.7)88.421<0.001
膀胱造瘘[例(%)]721.401<0.001
是470(68.8)455(66.6)34(5.0)
否213(31.2)228(33.4)650(95.0)
术前住院时间[d, M(Q1, Q3)]5.6(3.8, 7.1)4.7(3.5, 5.9)4.7(3.1, 6.7)35.453<0.001
术后住院时间[d, M(Q1, Q3)]5.7(4.8, 7.0)4.7(3.0, 5.9)2.8(1.0, 4.0)579.324<0.001
术后病理[例(%)]
良性增生670(98.1)661(96.8)653(95.5)7.580.023
癌或异常13(1.9)22(3.2)31(4.5)
术中及术后输血[例(%)]31(4.5)21(3.1)6(0.9)16.891<0.001
), ArticleFig(id=1198558119753253233, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558111649858518, language=CN, label=表2, caption=

本中心2012年1月至2022年8月良性前列腺增生(BPH)手术治疗患者的手术情况

, figureFileSmall=null, figureFileBig=null, tableContent=
指标前期组(n=683)中期组(n=683)后期组(n=684)F/H/χ2P
手术时间[min, M(Q1, Q3)]108.0(80.0, 130.0)80.0(60.0, 110.0)75.0(60.0, 100.0)194.353<0.001
术后膀胱冲洗时间[d, M(Q1, Q3)]1.9(1.2, 2.9)1.9(1.3, 2.9)1.7(0.8, 2.7)0.7160.699
术后尿管留置时间[d, M(Q1, Q3)]4.1(2.7, 5.9)3.9(2.9, 4.9)2.7(0.9, 3.9)167.597<0.001
膀胱造瘘时间[d, M(Q1, Q3)]3.9(2.9, 5.3)2.9(2.5, 3.9)3.6(2.1, 4.7)88.421<0.001
膀胱造瘘[例(%)]721.401<0.001
是470(68.8)455(66.6)34(5.0)
否213(31.2)228(33.4)650(95.0)
术前住院时间[d, M(Q1, Q3)]5.6(3.8, 7.1)4.7(3.5, 5.9)4.7(3.1, 6.7)35.453<0.001
术后住院时间[d, M(Q1, Q3)]5.7(4.8, 7.0)4.7(3.0, 5.9)2.8(1.0, 4.0)579.324<0.001
术后病理[例(%)]
良性增生670(98.1)661(96.8)653(95.5)7.580.023
癌或异常13(1.9)22(3.2)31(4.5)
术中及术后输血[例(%)]31(4.5)21(3.1)6(0.9)16.891<0.001
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单中心10年2050例良性前列腺增生手术围手术期数据分析
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杨国荣 1, 2 , 吕超 1, 3 , 吕凯凯 1, 2 , 吴洋洋 1, 2 , 宋涛 1 , 袁清 1, *
解放军医学杂志 | 临床研究 2024,49(9): 992-997
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解放军医学杂志 | 临床研究 2024, 49(9): 992-997
单中心10年2050例良性前列腺增生手术围手术期数据分析
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杨国荣1, 2, 吕超1, 3, 吕凯凯1, 2, 吴洋洋1, 2, 宋涛1, 袁清1, *
作者信息
  • 1解放军总医院第三医学中心泌尿外科医学部，北京 100039
  • 2解放军医学院研究生院，北京 100017
  • 3空军特色医学中心泌尿外科，北京 100142

    • 杨国荣，硕士研究生，主要从事泌尿外科前列腺疾病及下尿路战创伤方面的研究

通讯作者:

袁清，E-mail：
Data analysis of perioperative period in 2050 cases of benign prostatic hyperplasia surgery in a single center over 10 years
Guo-Rong Yang1, 2, Chao Lyu1, 3, Kai-Kai Lyu1, 2, Yang-Yang Wu1, 2, Tao Song1, Qing Yuan1, *
Affiliations
  • 1Senior Department of Urology, the Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
  • 2Medical School of Chinese PLA, Beijing 100017, China
  • 3Department of Urology, Air Force Speciality Medical Center, Beijing 100142, China
出版时间: 2024-09-28 doi: 10.11855/j.issn.0577-7402.0864.2023.1130
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摘要
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目的 总结分析良性前列腺增生(BPH)手术术式的变化及临床疗效。方法 回顾性分析2012年1月-2022年8月于解放军总医院第一医学中心泌尿外科接受BPH手术治疗的2050例患者的临床资料。按时间顺序将患者分为前期组(n=683)、中期组(n=683)、后期组(n=684)，各组患者累计时间分别为2012年1月-2017年2月、2017年3月-2020年9月及2020年10月-2022年8月。收集并比较各组患者年龄、高血压、糖尿病、血清胆固醇、血清三酰甘油、血清高密度脂蛋白胆固醇、体重指数(BMI)、术前前列腺体积、前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)、手术时间、术前住院时间、术后住院时间、术后膀胱冲洗时间、术后尿管留置时间、膀胱造瘘情况、术中和术后输血情况、术后再入院率、术后病理等指标。分析BPH手术量及手术方式的逐年变化趋势。结果 经尿道前列腺电切术(TURP)及TURP+激光术式逐年减少，而经尿道前列腺激光剜除术占比不断增高，并在近两年成为主流术式；前期组、中期组、后期组患者年龄分别为(69.7±7.9)岁、(68.7±7.4)岁和(69.8±8.5)岁(P=0.027)；手术时间分别为108.0(80.0，130.0) min、80.0(60.0，110.0) min和75.0(60.0，100.0) min (P<0.001)；术后尿管留置时间分别为4.1(2.7，5.9) d、3.9(2.9，4.9) d和2.7(0.9，3.9) d(P<0.001)；膀胱造瘘率分别为68.8%、66.6%和5.0%(P<0.001)；术中及术后输血率分别为4.5%、3.1%、0.9%(P<0.001)；术前住院时间分别为5.6(3.8，7.1) d、4.7(3.5，5.9) d和4.7(3.1，6.7) d(P<0.001)；术后住院时间分别为5.7(4.8，7.0) d、4.7(3.0，5.9) d和2.8(1.0，4.0) d (P<0.001)，差异均有统计学意义。本中心10年BPH手术患者术后再次入院37例(1.8%)，术后病理异常或病理确诊为前列腺癌64例，总检出率为3.1%。结论 前列腺激光剜除术已成为本中心BPH外科治疗的主流术式，手术时间、住院时间、术后尿管留置时间、膀胱造瘘率、手术输血率等围手术期相关指标均呈现明显改善的趋势。

良性前列腺增生  /  手术治疗  /  术式  /  围手术期

Objective To summarize and analyze the surgical evolution and clinical efficacy of benign prostatic hyperplasia (BPH) surgery. Methods A retrospective cohort study was used to analyze the clinical data of 2050 patients who underwent surgery for BPH in the Department of Urology, the First Medical Center of PLA General Hospital from January 2012 to August 2022. These patients were divided into 3 groups in chronological order: the early group (n=683), the middle group (n=683) and the late group (n=684). The cumulative time of patients in each group was from January 2012 to February 2017, March 2017 to September 2020 and October 2020 to August 2022. The indicators, such as age, hypertension, diabetes, serum cholesterol, serum triacylglycerol, serum high-density lipoprotein cholesterol, body mass index (BMI), preoperative prostate volume, prostate specific antigen (PSA), free prostate specific antigen (fPSA), operation time, preoperative hospital stay, postoperative hospital stay, postoperative bladder flushing time, postoperative indwelling time, cystostomy situation, intraoperative and postoperative blood transfusion, postoperative readmission rate, and postoperative pathology were collected and compared between 3 groups, and the annual trend of changes in the number of BPH surgeries and surgical methods was analyzed. Results Transurethral resection of prostate (TURP) and TURP+laser resection decreased year by year, while transurethral laser resection of prostate increased and became the mainstream prostate resection method in recent two years, accounting for more than 90%. The patients in the early, middle and late groups were (69.7±7.9) years old, (68.7±7.4) years old and (69.8±8.5) years old (P=0.027); the operation time was 108.0(80.0, 130.0) min, 80.0(60.0, 110.0) min and 75.0 (60.0, 100.0) min (P<0.001); the postoperative indwelling time was 4.1(2.7, 5.9) d, 3.9(2.9, 4.9) d and 2.7(0.9, 3.9) d (P<0.001); the rates of cystostomy were 68.8%, 66.6% and 5.0% (P<0.001); the intraoperative and postoperative blood transfusion rates were 4.5%, 3.1% and 0.9% (P<0.001); the preoperative hospitalization time was 5.6(3.8, 7.1) d, 4.7(3.5, 5.9) d, and 4.7(3.1, 6.7) d (P<0.001); the postoperative hospital stays were 5.7(4.8, 7.0) d, 4.7(3.0, 5.9) d and 2.8(1.0, 4.0) d (P<0.001), with statistically significant differences. Thirty-seven cases (1.8%) of BPH patients who underwent surgery in our center for 10 years were re-admitted after surgery, and 64 cases had postoperative pathological abnormalities or were diagnosed with prostate cancer, with a total detection rate of 3.1%. Conclusions Laser enucleation of prostate has become the mainstream surgical treatment of BPH in our center, and perioperative indexes such as operation time, hospital stay, postoperative catheter indwelling time, cystostomy rate, and surgical blood transfusion rate have shown a significant improvement trend.

benign prostatic hyperplasia  /  surgical treatment  /  surgical method  /  perioperative period
杨国荣, 吕超, 吕凯凯, 吴洋洋, 宋涛, 袁清. 单中心10年2050例良性前列腺增生手术围手术期数据分析. 解放军医学杂志, 2024 , 49 (9) : 992 -997 . DOI: 10.11855/j.issn.0577-7402.0864.2023.1130
Guo-Rong Yang, Chao Lyu, Kai-Kai Lyu, Yang-Yang Wu, Tao Song, Qing Yuan. Data analysis of perioperative period in 2050 cases of benign prostatic hyperplasia surgery in a single center over 10 years[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (9) : 992 -997 . DOI: 10.11855/j.issn.0577-7402.0864.2023.1130
正文
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良性前列腺增生(benign prostate hyperplasia，BPH)是中老年男性常见的良性疾病，也是引起中老年男性下尿路症状(lower urinary tract symptom，LUTS)的首要因素[1]。近年来随着老龄化的加重，我国BPH的发病率大幅增长，疾病负担一直维持在较高水平[2]。目前BPH治疗主要包括药物干预及手术治疗，对于药物治疗失败或有BPH并发症的患者，应当进行手术干预[3-4]。一直以来经尿道前列腺电切术(transurethral resection of prostate，TURP)都被认为是治疗BPH的“金标准”[5-6]，但随着激光技术的发展，BPH的手术方式也发生了变化，基于各类激光平台的前列腺剜除术展现出了不亚于或者优于TURP的疗效[7]。本研究回顾性分析解放军总医院第一医学中心近10年来BPH手术方式的演变及围手术期相关指标的变化情况，以期揭示我国BPH手术逐渐走向微创化的发展历程，探究未来我国BPH手术的发展方向。
1 资料与方法
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1.1 研究对象
回顾性分析2012年1月-2022年8月于解放军总医院第一医学中心(原解放军总医院)泌尿外科接受BPH手术治疗的2050例患者的临床资料。按文献[8]的方法，依据时间顺序将患者分为前期组(n=683)、中期组(n=683)与后期组(n=684)，各组接受手术治疗的时间分别为2012年1月-2017年2月、2017年3月-2020年9月及2020年10月-2022年8月。
1.2 观察指标
(1)收集患者年龄、民族、地域、费别、吸烟、饮酒及术前前列腺体积、前列腺特异性抗原(prostate-specific antigen，PSA)、游离前列腺特异性抗原(free prostate-specific antigen，fPSA)等指标。由于BPH与代谢综合征密切相关[9]，因此选择高血压、糖尿病、血清胆固醇、血清三酰甘油、血清高密度脂蛋白胆固醇、体重指数(body mass index，BMI)等指标进行描述。(2)BPH手术量及手术方式的逐年变化趋势。(3)手术情况，包括手术时间、术前住院时间、术后住院时间、术后膀胱冲洗时间、术后尿管留置时间、膀胱造瘘情况、术中及术后输血情况。(4)术后再入院率、术后病理等其他指标。
1.3 统计学处理
采用SPSS 26.0软件进行统计分析。符合正态分布的计量资料以$\bar{x}±s$表示，多组间比较采用方差分析，进一步两两比较采用LSD-t检验；不符合正态分布的计量资料以M(Q1，Q3)表示，多组间比较采用Kruskal-Wallis秩和检验，进一步两两比较采用Kruskal-Wallis单因素ANOVA检验(多样本)；计数资料以例(%)表示，多组间比较采用χ2检验，进一步两两比较采用Z检验(Bonferroni correction)。采用线性回归分析手术量与年份变化及手术时间之间的关系。均采用双侧检验，P<0.05为差异有统计学意义。
2 结果
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2.1 基线资料
共纳入2050例行BPH手术的患者，3组民族，血清胆固醇、三酰甘油、高密度脂蛋白胆固醇水平，BMI，术前前列腺体积，以及术前PSA、fPSA水平差异均无统计学意义(P>0.05)。3组患者年龄分别为(69.7±7.9)岁、(68.7±7.4)岁、(69.8±8.5)岁，差异有统计学意义(P=0.027)，其中中期组患者年龄小于前期组和后期组(P<0.05)；前期组和中期组以外地患者为主(64.0%和67.2%)，后期组以北京本地患者为主(63.9%)；在费别方面，3组患者全费比例依次下降，医保比例逐渐升高(P<0.001)；此外，后期组高血压及糖尿病并发率均高于前期组和中期组(P<0.001)；中期组吸烟、饮酒比例均高于前期组和后期组(P<0.001) (表1)。
2.2 手术量及手术方式
2012年1月-2022年8月，BPH手术量呈逐年增加趋势(y=20.521x-412000.024，R2=0.476，P=0.027；图1A)。随着时间的推移，BPH手术术式也发生了变化，耻骨上经膀胱前列腺增生部切除术在近10年中已基本被淘汰，经尿道等离子前列腺剜除术主要在2016-2019年期间使用，在前8年中BPH手术方式以TURP及TURP+激光术式为主，但总体趋势为逐年减少，而单纯的经尿道前列腺激光剜除术占比不断增高，且在近两年的BPH手术中占比达到90%以上(图1B)。
2.3 手术时间及手术情况
BPH手术时间随年份变化呈现下降趋势(y=-5.455x+11093.182，R2=0.912，P<0.001；图2)。前期组、中期组、后期组BPH患者的手术时间分别为108.0(80.0，130.0) min、80.0(60.0，110.0) min和75.0(60.0，100.0) min，3组患者手术时间依次缩短(P<0.001)。
前期组、中期组、后期组BPH患者的术后膀胱冲洗时间分别为1.9(1.2，2.9) d、1.9(1.3，2.9) d和1.7(0.8，2.7) d，差异无统计学意义(P=0.699)。3组术后尿管留置时间分别为4.1(2.7，5.9) d、3.9(2.9，4.9) d和2.7(0.9，3.9) d，与前期组和中期组比较，后期组术后尿管留置时间缩短(P<0.001)，而前期组与中期组术后尿管留置时间差异无统计学意义(P=1.000)。3组膀胱造瘘率分别为68.8%、66.6%和5.0%，与前期组和中期组比较，后期组膀胱造瘘率明显下降(P<0.001)，而前期组与中期组膀胱造瘘率差异无统计学意义(P=0.895)。3组术中及术后输血率分别为4.5%、3.1%、0.9%，与前期组和中期组比较，后期组输血率明显下降(P<0.001)，而前期与中期组输血率差异无统计学意义(P>0.05)。
3组术前住院时间分别为5.6(3.8，7.1) d、4.7(3.5，5.9) d和4.7(3.1，6.7) d，与前期组比较，中期组和后期组术前住院时间缩短(P<0.001)，而中期组与后期组术前住院时间差异无统计学意义(P=0.441)。3组术后住院时间依次缩短，分别为5.7(4.8，7.0) d、4.7(3.0，5.9) d和2.8(1.0，4.0) d，差异有统计学意义(P<0.001) (表2)。
2.4 术后再入院率及术后病理
本中心10年BPH手术患者再次入院37例(1.8%)，入院间隔时间为3.0(1.0，5.0)个月，其中12例为尿道狭窄，6例为术后血尿，5例为术后BPH复发，3例为膀胱颈挛缩，3例为尿潴留，其他原因8例(包括附睾炎、膀胱肿瘤、尿痛、尿失禁等)。术后病理异常或病理确诊为前列腺癌64例，总检出率为3.1%，其中前列腺激光剜除术检出31例，检出率为1.5%，TURP+激光术检出29例，检出率为1.4%，前列腺等离子剜除术4例，检出率为0.2%。
3 讨论
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全球范围内BPH的发病例数在近20年大幅增加[10]，且全球疾病负担研究发现，LUTS/BPH给人类带来的负担迅速增加，远远超过泌尿系统其他疾病[11]。
外科手术是解除BPH梗阻症状最为有效的治疗方式，美国每年约有10万次BPH手术[12]。TURP一直以来都被认为是治疗BPH的金标准术式[13]，但其可能引起严重的并发症，如大出血、经尿道电切综合征等[14]，同时随着患者缩短住院时间、减少术后并发症、降低医疗费用的意愿不断增强，泌尿外科医师希望开发创伤更小、并发症更少的新型手术技术。微创手术在20世纪90年代得到了应用[5]，特别是高功率激光的应用加快了经尿道前列腺激光剜除术的推广和使用[7,15]。同时，TURP的应用呈现下降趋势。王焕瑞等[16]回顾2004-2013年北京大学人民医院10年TURP手术情况发现，随着时间的推移TURP手术量不断减少；而韩国对BPH手术数据的研究发现，随着时间的推移TURP手术量仍保持稳定[17]，相比之下，钬激光前列腺剜除术(holmium laser enucleation of the prostate，HoLEP)的应用大幅增加[17-18]；Uhlig等[19]报道了德国BPH手术情况，其中TURP仍是其主要手术方式，但激光术式的应用在不断增加，这些手术方式的变化趋势与本中心基本一致。
本中心BPH手术的手术时间、术前住院时间、术后住院时间、术后尿管留置时间、膀胱造瘘率以及输血率等围手术期指标近年来显著改善，分析原因为：一方面BPH手术技术不断改良；另一方面与前列腺激光剜除术的使用率不断增高有关。本中心使用激光包括绿激光、铥激光及钬激光，近两年主要以钬激光为主。钬激光是一种脉冲固体激光，其波长为2140 nm，这种波长的激光可被水强烈吸收，使其在水环境中可安全使用[20]。近年来多项研究表明，虽然HoLEP在功能结局和并发症方面与TURP无明显差异，但在手术时间、住院时间、术后尿管留置时间、膀胱冲洗时间、出血量以及手术输血率等方面有明显优势，在成本效益方面更为合理[21-24]，且其手术安全性更有保证[25]。同时，由于HoLEP止血效果优于TURP，因此HoLEP术后膀胱造瘘冲洗率及输血率明显下降。另外，HoLEP也是唯一的美国泌尿外科学会指南认可的适用于所有前列腺大小的前列腺切除方式[5,26]。此外，中期分组患者其所接受的术式主要以TURP或TURP+激光术式为主，在进行TURP手术时为保证术中冲洗的通畅，并及时将TURP过程中所产生的前列腺组织碎块快速冲出术野，同时也为保证术中术野区域低压状态减少TURP综合征的发生，本中心大部分术者进行了常规膀胱穿刺造瘘，因此导致中期组膀胱造瘘率明显高于后期组。后期组患者所接受的术式主要以激光前列腺剜除术为主，基于激光操作的优势，本中心术者目前已基本不再进行常规膀胱穿刺造瘘。这也是后期组患者膀胱造瘘率下降幅度巨大的重要原因。
BPH与前列腺癌具有许多相似之处。二者发病率均随年龄的增加而增高，并且二者均需要雄激素来促进生长，对抗雄激素治疗方案有反应。He等[27]分析不同BPH术式的前列腺癌检出率发现，HoLEP组前列腺癌总检出率(6.24%)高于TURP组(3.94%)。尽管本中心前列腺激光剜除术的检出率也高于TURP+激光术式，但总检出率为3.1%，分析原因可能与本中心更为严格的术前筛查流程有关。术后再入院率方面，Shamout等[28]发现，TURP术后30 d再入院率为7.4%，60 d为9.5%，90 d为11.1%，这一比例高于本中心BPH患者的术后再入院率(1.8%)，分析原因可能与手术技术水平以及患者居住地和就医便捷程度有关。
综上所述，本中心泌尿外科BPH手术在过去10年的历程中发生了较大变化。TURP或TURP+激光术式的使用逐渐减少，而单纯前列腺激光剜除术的应用不断增加，并在近两年达到90%以上，前列腺激光剜除术已经成为本中心BPH手术的首选和主流术式；本中心BPH手术量也在逐年增加，同时手术时间、住院时间、术后尿管留置时间、膀胱造瘘率、手术输血率等围手术期指标均呈现明显改善的趋势。但本研究为回顾性研究，可能存在信息偏倚，具体术式疗效的对比尚待前瞻性对照研究提供更为高质量的临床证据。本次单中心长时间大样本的分析，有望映射我国BPH手术的演变历程，同时希望对未来制定BPH卫生规划提供参考。
基金
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  • 国家重点研发计划(2021YFC2009304)
  • 北京市科技新星计划交叉合作课题(20220484230)
文献
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2024年第49卷第9期
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doi: 10.11855/j.issn.0577-7402.0864.2023.1130
  • 接收时间：2023-06-20
  • 首发时间：2025-11-21
  • 出版时间：2024-09-28
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  • 收稿日期：2023-06-20
  • 录用日期：2023-08-23
基金
National Key Research and Development Program of China(2021YFC2009304)
国家重点研发计划(2021YFC2009304)
Beijing NOVA Program(20220484230)
北京市科技新星计划交叉合作课题(20220484230)
作者信息
    1解放军总医院第三医学中心泌尿外科医学部，北京 100039
    2解放军医学院研究生院，北京 100017
    3空军特色医学中心泌尿外科，北京 100142

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
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