KTP激光汽化术治疗高龄高危良性前列腺增生的临床观察

Photoselective potassium-titanyl-phosphate laser vaporization prostatectomy for the treatment of high-risk patients with benign prostatic hyperplasia

目的探讨高能磷酸钛氧钾晶体（KTP）激光前列腺汽化术（PVP）和双极等离子体电切术（PKRP）治疗高龄高危良性前列腺增生（BPH）的有效性及安全性。方法采用80WKTPPVP术治疗高龄高危患者共166例：其中62例行PKRP＋PVP术。患者年龄80—95岁，平均83岁；前列腺体积17-278ml，平均74ml，其中80ml以上36例（21．7％）。患者平均国际前列腺症状评分（IPSS）为（28±4）分，平均生活质量评分（QOL）为（5．3±0．7）分；入院时留置导尿者72例（43．4％）。其余患者平均最大尿流率（Qmax）为（6．9±3．2）ml／s。结果本组平均手术时间（92±28）min，平均汽化能量（127±99）kJ；平均术中出血量（121±92）ml，其中9例术中有较明显出血并需要输血，均为术前服用抗凝药物者。术中未出现电切综合征（TURS）迹象。术后1。4d后拔除导尿管，平均（2．9±1．1）d，其中9例因排尿困难、2例因残尿过多而再次留置导尿1-3d拔管排尿通畅，其余患者术后均排尿通畅。出院时IPSS平均（11±2）分，QOL平均（2．0±0．6，Qmax平均（12．6±5．2）ml／s；术后3月和6月的IPSS、QOL分别为（11±4）分，（11±3）分和（1．9±0．4）分，（1．8±0．4）分。结论PVP术或PKRP＋PVP术是治疗高龄高危前列腺增生安全而有效的方法，可明显提高患者生活质量。

Objective To evaluate the safety and efficacy of photoselective vaporization of the prostate（PVP） and plasmakinetic resection of the prostate（PKRP） in the treatment of high-risk patients with benign prostatic hyperplasia（BPH）. Methods From Jan 2004 to May 2006, a total of 166 high-risk men aged 80 to 95 years （mean age of 83 years） underwent PVP using an 80W potassium-titanyl-phosphate（KTP） laser. Among them 62 patients were treated by PVP plus PKRP. International Prostate Symptom Score （IPSS）, quality of life （QOL）, operative time, blood loss, indwelling eatheterzation, maximum flow rate （Qmax）, serum prostate specific antigen （PSA）, postvoid residual urine volume（PVR） and short-term complication rates were evaluated for all patients. Results Mean prostate volume was （74±4 l） ml. Mean operative time and mean energy delivery were （92±28） min and （127±99） kJ, respectively. No patient had TURS. Foley catheters were removed in 1-4d postoperatively. Mean Qmax at discharge was （12.6±5.2）ml/s. All patients remained satisfied with voiding outcome, which changed significantly （P〈0.01）. Mean IPSS decreased to 11±4, 11±3 at 3and 6 months, respectively, from the baseline of 28±4. Conclusion 80W KTP PVP and PKRP＋PVP in the treatment of high-risk patients with BPH are safe and effective with a high rate of patient satisfaction.