经尿道绿激光汽化联合电切割治疗前列腺增生的应用与创伤评价

Application of photoselective vaporization combined with transurethral resection prostate in the treatment of benign prostatic hyperplasia and the assessment of the degree of trauma

目的:应用定量指标白细胞介素6和C-反应蛋白评估经尿道绿激光联合电切割手术对机体的创伤程度,进而评价其治疗老年前列腺增生的可行性。方法:选择2005-06/2006-04在解放军第四军医大学西京医院住院的良性前列腺增生患者98例(年龄>60岁),分别行开放性手术(28例)、经尿道绿激光汽化合并电切割术(PVP+TURP组,33例)和经尿道绿激光汽化术(PVP组,37例)。绿激光汽化采用美国Laserscope公司生产的非接触式绿激光治疗系统,额定输出汽化功率为80W,电凝功率为30W。用酶联免症吸附法测定3组患者手术前2h,术后24,48h血清中白细胞介素6和C-反应蛋白水平。结果:98例患者全部进入结果分析。①血清白细胞介素6水平:术前2h3组比较差异不显著(P>0.05),术后24和48h均明显高于术前(P<0.05);术后24,48h开放性手术组高于PVP组和PVP+TURP组[24h:(5.97±1.35),(1.81±1.64),(2.44±1.45)μg/L,P<0.05;48h:(1.63±0.86),(0.77±0.51),(0.80±1.46),P<0.05]。②血清C-反应蛋白水平:术前2h3组比较差异不显著(P>0.05),术后24和48h均明显高于术前(P<0.05);术后24,48h开放性手术组高于PVP组和PVP+TURP组[24h:(62.38±13.65),(10.03±4.05),(28.57±9.8)mg/L,P<0.05;48h:(118.85±20.82),(38.86±8.35),(69.44±13.66),P<0.05];PVP+TURP组高于PVP组(P<0.05)。结论:在这3种术式中,开放性手术对机体的创伤最大,机体急性时相反应最显著,经尿道绿激光汽化术合并电切割术对机体创伤较轻,可用于治疗老年前列腺增生症。

AIM： To investigate the application of photoselective vaporization （PVP） combined with transurethral resection prostate （TURP） and access the traumatic degree of open operation （OP）, PVP or photoselective vaporization combined with transurethral resection of the prostate （PVP＋TURP）. METHODS： Ninety-eight inpatients （who were older than 60 years） with benign prostatic hyperplasia （BPH） were selected from Xijing Hospital Affiliated to Fourth Military Medical University of Chinese PLA between June 2005 and April 2006. Patients underwent surgical treatments; OP （n =28）, PVP （n =37） and PVP＋TURP （n =33） respectively. The PVP that adopted was non-contact PVP system designed by American Laserscope Company, and the vaporized power of nominal out was 80 W and the electric coagulation power was 30 W. The enzyme linked immunosorbent assay （ELISA） was used to detect the levels of interleukin-6 （IL-6） and C reactive protein （CRP） of patients in all groups at two hours before the operation, 24 hours, and 48 hours after he operation respectively. RESULTS ： Totally 98 patients were involved in the analysis of results. ① The level of serum IL-6： There was no significant difference among the three groups at two hours before the operation （P 〈 0.05）, while it was significantly higher at 24 hours and 48 hours after the operation than that before the surgery （P 〈 0.05）. Moreover, it was higher in the OP group than that in the PVP group and PVP＋TURP group at 24 and 48 hours after the operation [24^th hour： （5.97±1.35）, （ 1.81 ±1.64 ）, （2.44±1.45） ug/L, P 〈 0.05; 48^th hour： （ 1.63±0.86）, （0.77±0.51）, （0.80±1.46）, P 〈 0.05]. Level of serum CRP： No significant difference was found among the three groups at 2 hours before the operation （P 〉 0.05）, while it was significantly higher at 24 and 48 hours after the operation than that before the surgery （P 〈 0.05）, and it was higher in the OP group at 24 and 48 hours after the surgery than that in the PVP group and PVP＋TURP group [24^th hour： （62.38±13.65）, （10.03±4.05）, （28.57±9.8） mg/L,P 〈 0.05;48= hour： （118.85±20.82）, （38.86±8.35）, （69.44±13.66） ,P 〈 0.05]. Besides, it was higher in the PVP＋TURP group than that in the PVP group （P 〈 0.05）. CONCLUSION： Extent of tissue damage and the degree of acute phase reaction by OP are the severest and the least by PVP, which can be adopted in the treatment of BPH in eldedy patients.