选择性绿激光汽化联合经尿道前列腺电切治疗前列腺增生

Greenlight photoselective vaporization prostatectomy and transurethral resection of prostate for the treatment of benign prostatic hyperplasia

目的 探讨经尿道选择性绿激光前列腺汽化术（PVP）结合经尿道前列腺电切术（TURP）治疗前列腺增生（BPH）的安全性和疗效.方法 单纯行经尿道前列腺电切术130例患者作为对照组,216例前列腺增生患者作为治疗组,应用PVP先汽化前列腺至凝固层形成,换用TURP切除凝固层及剩余腺体.观察2组术中出血情况、手术时间、术后留置尿管时间、手术前后尿流率、国际前列腺症状评分（IPSS）、生活质量评分（QOL）及性功能变化情况.结果 治疗组全部麻醉效果满意,手术顺利.手术时间20～160 min,平均（45±22）min,术中无输血病例;术后常规留置尿管,留置尿管时间48～96 h,平均（34 ±27）h;拔管后2例出现短暂排尿困难、2例继发出血、2例短暂性尿失禁;术后3个月随访128例,最大尿流率由术前平均（5.9 ±2.1）ml/s增加至术后（18.4 ±2.5）ml/s,IPSS及QOL与术前比较均有明显改善,差异有统计学意义（P＜0.05）;71例术前性功能良好者,术后均保留良好性功能.对照组130例中17例出现勃起功能障碍,治疗组较对照组术中出血量少,手术时间与术中留置尿管时间均较短,差异具有统计学意义.结论 PVP联合TURP是治疗前列腺增生安全有效的方法,具有出血少、留置尿管时间短、术后排尿症状改善明显、性功能影响小的优点.

Objective To study the safety and efficacy of high-power greenlight photoselective vaporization prostatectomy （PVP） and transurethral resection of prostate in treating benign prostatic hyperplasia （BPH）.Methods A total of 216 patients with symptomatic bladder outlet obstruction due to BPH underwent PVP and TURP via transurethral.The therapeutic results were assessed using following variables： blood loss, operative time,indwelling catheterization, mean Qmax, IPSS, QOL and the sexual function.Results The PVP and TURP was successfully performed on all the 216 patients with BPH.The mean operative time was （45 ± 22）min （range, 20 ～160 min）, no patients required blood transfusion.The mean catheterization time was （34 ±27）h （range,48～96 h） in all.Postoperatively 2 cases had transient dysuria and 2 cases experienced delayed hematuria.128 cases were followed up 3 months after treatment.The mean Qmax increased from （5.9 ± 2.1） ml/s to （18.4 ±2.5） ml/s;mean IPSS and QOL were improved significantly and significant difference was found（P 〈0.05）.The 71 cases with sexal function still remained potent postoperatively.Conclusion The PVP and TURP is safe and effective relief for patients with obstructive BPH with minimal invasion.