微创泌尿外科杂志

目的 探究改良局部麻醉下经尿道前列腺切开术治疗老年多并发症良性前列腺增生患者的安全性和有效性。方法 通过回顾性队列研究，纳入2022年6月至2024年11月于解放军联勤保障部队第九八二医院普通外科接受外科治疗的多并发症老年前列腺增生患者共195例，其中接受改良局部麻醉下手术65例（LA组），传统硬膜外麻醉下手术130例（对照组），采用倾向性匹配评分按照1∶1比例配对后两组各60例。对一般临床资料、手术相关安全性及有效性数据进行分析,计量资料组间对比采用配对样本t检验,等级资料组间对比采用配对秩和检验,计数资料组间比较采用McNemar检验。结果 两组患者基线资料可比性良好。安全性指标方面，LA组患者住院时间较对照组更短（P<0.001），两组手术时间、术中患者生命体征、VAS痛觉评分及术后不良事件比较差异均无统计学意义（P>0.05）；有效性指标方面，两组比较差异均无统计学意义[国际前列腺症状评分（IPSS）改善P=0.817，最大尿流率（Qmax）改善P=0.950]。结论 改良局部麻醉下经尿道前列腺切开术对于老年多并发症良性前列腺增生患者是安全有效的，并且由于麻醉方式的改变，对于患者基础疾病情况更为宽容，术后快速康复出院，有利于患者更安全、便捷地接受手术治疗。

Methods A retrospective cohort study was conducted, and 195 elderly BPH patients with multiple comorbidities who underwent surgical treatment in the Department of General Surgery, the 982 nd Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2022 to November 2024 were included. Among them, 65 patients underwent surgery under modified local anesthesia(LA group) and 130 patients under traditional epidural anesthesia(control group). After propensity score matching at a 1:1 ratio, there were 60 patients in each group. General clinical data, surgery-related safety and efficacy data were analyzed. Paired samples t-test was used for comparison of measurement data between groups, paired rank sum test for ranked data, and McNemar test for count data. Results The baseline data of the two groups were comparable. In terms of safety indicators, the length of hospital stay in the LA group was significantly shorter than that in the control group(P<0.001), while there were no statistically significant differences in operation time, intraoperative vital signs of patients, Visual Analogue Scale(VAS) pain score, and postoperative adverse events between the two groups(P>0.05). In terms of efficacy indicators, there were no statistically significant differences between the two groups [improvement in International Prostate Symptom Score(IPSS): P=0.817; improvement in maximum urinary flow rate(Qmax): P=0.950]. Conclusion TUIP under modified local anesthesia is safe and effective for elderly BPH patients with multiple comorbidities. Due to the change in anesthesia method, it is more tolerant to patients' underlying diseases, enabling rapid postoperative recovery and discharge, which is conducive to patients receiving surgical treatment more safely and conveniently. Objective To explore the safety and efficacy of transurethral incision of the prostate(TUIP) under modified local anesthesia in the treatment of elderly patients with benign prostatic hyperplasia(BPH) and multiple comorbidities.