接触与非接触式激光经尿道前列腺切除术(附51例报告)

Transurethral prostatectomy with contact/noncontact laser system

为探讨并发症少、死亡率低的治疗前列腺增生症（BPH）的更有效方法，采用接触与非接触式激光联合治疗BPH51例。术中先以接触式激光将5、7点间腺体切除，再以非接触式侧射探头高功率（60W）照射树叶腺体致组织塌陷，扩大排尿通道。11例腺体较大、组织炭化重者加用经尿道前列腺切除术（TURP）。结果51例中，48例成功，3例因腺体≥80ml改行开放手术。术后随访1～12个月，平均6.6个月，平均最大尿流率17．2±4．4ml／s，IPSS平均递减8.5分。认为接触与非接触式激光联合经尿道前列腺切除术安全有效，适用于具有前列腺增生梗阻、刺激症状重的高危患者，腺体较大及中叶凸向膀胱2cm者，单独使用激光效果不佳，可在激光气化、凝固腺体基础上酌加TURP。腺体≥80ml或中叶凸向膀胱＞3cm者，不适宜腔内治疗。

51 cases of benign prostatic hyperplasia treated with Nd: YAG contact/noncontact laser system were reported. The age of the pathients ranged from 52 to 87 years. IPPS were 19-31,the average MRF was 9. 6 ml/s. The contact laser was first used to vaporizate the gland tissue between 5 and 7 o'clock and then the side-firing-free-beam laser was used in a relative high power (about 60 W) to coagulate the rest gland and to widen the prostaatic urethra. For 11 patients with large gland volumes and more charcoalized tissue after laser,TURP were attached to get rid off rest charcoalized gland. 48 cases have been followed up for 1- 11 months (mean 6. 6 months) with a satisfactory alleviative rate. The results suggested that the contact/noncontact laser system was suitable for high-risk BPH patients and for the patients with large gland,laser plus TURP were available,but,the effect was poor in the patients with predominantly median lobe hypertrophy (>3 cm) or the gland was over 80 ml in volume. Moreover,a urodynamic study was emphesized in preoperation.