经尿道选择性绿激光前列腺汽化术治疗高龄高危患者的临床观察

Evaluation of greenlight photoselective vaporization of prostate for the treatment of high risk older patients with benign prostatic hyperplasia

目的评估经尿道选择性绿激光前列腺汽化术(photoselective vaporization of prostate,PVP)治疗高龄高危患者的安全性及疗效。方法采用PVP治疗高龄高危良性前列腺增生(benign prostatic hyperplasia,BPH)患者63例,观察平均手术时间、术中出血量、术后留置导尿管时间、手术并发症,记录并计算手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、剩余尿量及尿流率改变等指标的差异。结果63例患者术后均未有心、肺、脑、肝和肾等系统疾病的加重。其平均手术时间(44.8±6.5)min,术中出血量(85.4±12.4)mL,术后留置尿管时间(3.5±0.5)d。IPSS及QOL评分由术前平均(30.8±4.3)及(6.2±0.6)分别下降至(9.5±1.3)及(2.6±0.4),最大尿流率由术前(6.3±2.1)mL/s增加至术后(17.4±3.6)mL/s,剩余尿量由术前(154.0±20.5)mL下降至术后(29.6±6.8)mL,手术前后比较差异均有统计学意义(P<0.05)。结论PVP是治疗高龄高危BPH的一种安全有效的微创手术,手术操作简单、时间短、出血少、术后恢复快。

[ Objective ] To evaluate the safety and efficacy of greenlight photoselective vaporization of prostate （PVP） in high risk older patients with benign prostatic hyperplasia （BPH）. [ Methods ] A total of 63 high risk older patients with BPH underwent PVP. The operativetime, bloodloss, indwelling catheterization and operative complications were observed. The variables such as IPSS, QOL, uroflowmetry, post-void residual urine volume （RUV） were recorded and calculated pre-operatively and post-operatively. [ Results ] All the 63 patients safely got through perioperative period. The preoperative concurrent diseases of heart, lung, brain, liver and kidney were not aggravated after PVP operation. The mean operative time was （44.8 ± 6.5） min, intraoperative blood loss was （85.4 ± 12.4） mL and postoperative indwelling catheterization was （3.5 ±0.5）d. IPSS and QOL scores decreased form preoperative （30.8 ± 4.3） and （6.2 ± 0.6） to postoperative （9.5 ± 1.3） and （2.6 ± 0.4） respectively. Qmax increased from（6.3 ± 2.1） mL/s to （17.4 ±3.6）mL/s, and RUV decreased from （154.0 ±20.5） mL to （29.6 ± 6.8） mL. There were significant differences of these parameters between pre-operation and pest-operation （P 〈0.05）. [ Conclusions ] The PVP is believed to be a safe, efficacious and minimally invasive procedure for older patients with high risk BPH. It is easier to manipulate with advantages of shorter operative time, less blood loss,better tolerance and rapid recovery.