经尿道等离子双极电切加绿激光汽化治疗大体积良性前列腺增生症

Clinical observation of bipolar plasmakinetic combined with green laser in treatment of larger volume benign prostate hyperplasia

目的分析等离子体经尿道前列腺电切术（PKRP）＋绿激光前列腺汽化术（PVP）治疗大体积前列腺增生症的有效性和安全性。方法总结05年6月～06年12月采用等离子体电切＋绿激光治疗体积100ml以上的良性前列腺增生症81例（100～279）ml,平均（136.1±31.6）ml。手术方法为先行PKRP术,随后再行PVP术;对前列腺表面血管扩张明显者,先用激光对前列腺进行汽化,随后行电切,最后再行PVP术。结果本组手术时间90～180min,平均135min,切除前列腺54～180g,平均（82.0±32.0）g,术中出现较明显出血并需要输血4例,均为术前服用抗凝药物者。术后留置导尿管1～4d。出院时平均最大尿流率：术前留置导尿管者13.4ml/s,未留置导管者16.8ml/s。结论PKRP＋PVP术对大体积前列腺增生症患者是一种安全、有效的微侵袭性方法;术前尿潴留者在术后短期内疗效不及无尿潴留者。

Objective To assess the feasibility, safety and efficacy of transurethral bipolar plasmakinetic combined with green laser in treatment of large volume benign prostatic hyperplasia（BPH）. Methods Between June 2005 and December 2006, 81 patients with large prostates （100～279 ml, mean 136.1±31.6） were treated with bipolar plasmakinetic prostate resection（PKRP） combined with Photoselective vaporization of the prostate （PVP） by green laser. Two operative methods were adopted： PKRP was first applied and then PVP performed on the patients; In cases where there was perceivable angiectasis on the surface of prostate, PVP was first applied to stop bleeding before PKRP was performed on prostate and after that PVP was applied again. Results The mean operative time was 135 min （range, 90 ～180 min）. Removing 54～180 of prostate （mean 82±32g） took 90～180 min （mean 135 min）. Intraoperative bleeding occurred in 4 patients and blood transfusion had to be carried out. All these patients had taken anticoagulant before operation. The catheters were removed 1～4 days after operation. The mean maximum urine flow rate before being discharged from hospital was 13.4 ml/s in those with catheters retension before operation and 16.8 ml/s in those without. Conclusion PKRP combine with PVP are safe, effective and minimally invasive for the treatment of large prostates. As far as short-time postoperative curative effect is concerned, it is less effective for those who had suffered urinary retention before operation than those who had not.