【摘要】 目的：探讨经尿道铥激光前列腺剜除术（ThuLEP）日间手术模式治疗前列腺增生(BPH)的安全性及可行性。方法：分析安徽医科大学第一附属医院2021年10月至2022年3月，经过门诊筛查并接受ThuLEP日间手术的56例BPH患者的临床资料。患者入院当天即安排手术，手术由同一医生完成，遵循解剖性腔内前列腺剜除术标准，麻醉苏醒后即常规进食水；术后第1天停膀胱冲洗并拔除导尿管，并进行出院评估。记录患者的基线资料、围手术期结果、康复速度，住院费用，并报道术后1月的功能结果及手术并发症发生率。结果：患者平均年龄为61.6±5.2(52～75)岁、前列腺体积为52.6(37.7,66.0)mL。所有患者手术均获成功，平均手术时间36.6(24.0,40.0)min。术后平均血红蛋白上升0.8±0.3 g/dL。术后平均膀胱冲洗时间16.3±2.1 h、留置导尿22.1±3.7 h。所有患者均于术后第一天上午出院，平均术后住院时间16.7±2.5 h、总住院时间21.6±0.5 h，平均住院费用13130±320元。术后1个月平均国际前列腺症状评分4.5(3.0,6.3)vs. 26.7(22.0,29.0)、生活质量评分1.5(1.0,2.0)vs. 5.0(5.0,6.0)、最大尿流率21.2(16.2,29.0)mL/s vs. 8.8(5.2,11.7)mL/s较术前均有明显改善(P均<0.01)。出院前5例需重新留置尿管，术后5例发生尿道狭窄、3例发生膀胱颈挛缩3例，无其它Clavien 2级及以上并发症发生。结论：本研究首次报道ThuLEP日间手术。初步结果显示，在病人合适及技术成熟的条件下，ThuLEP日间手术是一种治疗BPH安全、可行、经济、高效的模式，可以在有条件的医院推广。更多还原

【Abstract】 Objective:To evaluate the feasibility and safety of thulium laser transurethral enucleation of the prostate(ThuLEP)in the treatment of benign prostatic hyperplasia(BPH)in a day surgery mode. Methods:Between October 2021 and March 2022,a total of 56 BPH patients received outpatient screening and underwent day-surgery of ThuLEP in the First Affiliated Hospital of Anhui Medical University. Patients completed all preoperative examinations during the pre-hospitalization period,and the operation was arranged on the day of admission. All operations were performed by Dr. Zou. The operation followed the standard of anatomic prostatic enucleation,and the adenoma was completely removed(shown as video and illustrations). Drinking and eating started at the time of postoperative anesthesia revival. Bladder irrigation and urinary catheter were stopped on the first postoperative day and the subsequent discharge evaluation was conducted. The baseline data,perioperative results,rehabilitation,hospitalization expenses,functional results and complications at the first postoperative month were prospectively recorded. Results:Average age and prostate volume were 61.6±5.2(52-75)years and 52.6(37.7,66.0)mL,respectively. All procedures were successfully completed with a mean operation time of 36.6(24.0,40.0)min. All patients were allowed to drink and drink after recovery from anesthesia. A decrease in hemoglobin was 0.8±0.3 g/dL. Average postoperative irrigation was 16.3±2.1h,and indwelling catheterization time was 22.1±3.7 h. All patients were discharged in the morning on the first postoperative day. The average hospital stay was 16.7±2.5 h,the total hospital stay was 21.6±0.5 days and the total hospitalization cost was 13130±320 RMB. The 1-month follow-up results showed a substantial improvement in the International Prostate Symptom Score from 26.7(22.0,29.0)to 4.5(3.0,6.3),Quality of Life score from 5.0(5.0,6.0)to 1.5(1.0,2.0),andmaximum urinary flow rate from 8.8(5.2,11.7)mL/s to 21.2(16.2,29.0)mL/s(all P< 0.001). Five patients received indwelling catheterization after removal of the catheter.Five patients were diagnosed with anterior urethral stricture and three patients experienced bladder neck contracture.No other complications above Clavien grade II occurred in this study. Conclusion:This is the first report of ThuLEP in a ambulatory surgery mode. The preliminary results show that ambulatory surgery of ThuLEP is safe,feasible,economical and effective under the conditions of suitable patients and available techniques,and can be promoted in qualified hospitals. In addition,patients can eat and drink immediately after ThuLEP surgery,which can provide a reference for exploring and developing ThuLEP in outpatient setting or routine eating and drinking after BPH surgery.更多还原