选择性绿激光汽化术治疗70岁以上老年人良性前列腺增生症临床分析

Photoselective vaporization treatment on benign prostatic hyperplasia in the elderly over 70 years old

目的探讨选择性绿激光汽化术(photoselective vaporization of the prostate,PVP)治疗70岁以上老年人良性前列腺增生(BPH)的疗效与安全性。方法2004年8月至2005年12月,应用平均功率80 W、峰值功率280 W的高功率KTP激光行PVP治疗70～96岁有梗阻症状的BPH患者126例．前列腺体积24～86 ml．平均47．0ml。结果手术时间30～100 min,平均46．8 min。69例留置导尿管0～24 h,拔除后均能自行排尿。96例术后随访1～3个月,国际前列腺症状评分(IPSS)由(25．0±3．7)分下降至(16．3±2．0)分,差异有统汁学意义(P＜0．01)；最大尿流率(Qmax)由(5．8±2．7)ml/s上升至(16．3±4．8)ml/s(P＜0．01)。术后继发出血4例,尿路感染6例,急性附睾炎1例。结论PVP治疗BPH侵袭性小、安全、有效、康复快,是治疗老年人良性前列腺增生较为理想的微创手术方法。

Objective To investigate the efficacy and safety of photoselective vaporization treatment on benign prostatic hyperplasia（BPH）in the elderly over 70 years old. Methods From August 2004 to December 2005, a total of 126 patients with lower urinary tract symptoms secondary to BPH underwent photoselective vaporization of the prostate （PVP） with an 80 W quasicontinuous KTP laser. The patients aged between 70 and 96 years, （median 78. 0） , with 46 cases above 80 years. Prostatic volume was 24～86 ml, in an average of 47.0 ml, with 46 cases above 60 ml. Results The mean operative time was 46.8 min （range from 30 to 100 min）. After operation, the catheter was pulled out in 69 cases within 24 hours and the patients generally urinated well. At three -months follow-up, the mean I- PSS decreased significantly from （25.0±3.7） to （16.3±2.0） （P〈0.01）, while the Qmax increased from （ 5.8 ± 2.7 ） ml/ s to （ 16.3 ± 4.8） ml/ s （ P 〈 0.01 ）. Complications consisted of 4 cases of hematuria, 6 urinary infection and 1 acute epididymitis. Conclusions The study indicates that PVP, a minimal invasive surgical procedure, is a safe and effective procedure for the treatment of BPH in the elderly.