高功率绿激光治疗高龄高危前列腺疾病的疗效评价

Evaluation of 120 W greenlight HPS laser for photoselective vaporization of prostate in the treatment of aged high-risk patients with prostatic disease

目的探讨120W高功率绿激光选择性前列腺汽化术(HPS PVP)治疗高危前列腺疾病的疗效及安全性。方法对31例高危前列腺疾病患者进行HPS PVP。其中前列腺增生24例,前列腺癌7例。对手术时间、出血量、光纤能量消耗、术后留置导尿时间、并发症、最大尿流率、IPSS、QOL、残余尿等指标进行评价。结果 29例顺利完成手术。手术时间30～85min,平均(43±18.4)min。术中出血20～50mL,平均(26±10.7)mL。无输血病例。术中光纤能量平均消耗(247±38.1)kJ。术后留置导尿管时间24～96h,平均(38.8±15.1)h。无尿失禁、继发性出血、急性尿潴留再次手术病例。术后1月最大尿流率由术前平均(5.2±2.7)mL/s提高到(15.3±4.8)mL/s。IPSS评分由术前平均(24.4±3.2)减少到(7.8±2.5)。QOL由术前平均(5.1±0.3)减少到(2.5±0.2)。残余尿量由术前平均(251.3±38.8)mL减少到术后(32.5±9.2)mL。手术前后差异均有统计学意义(P<0.05)。结论 120W高功率PVP治疗高龄高危前列腺疾病患者,具有手术时间短,出血少,安全性高,术后并发症少,留置导尿管时间短等优点。不仅可作为高龄高危良性前列腺增生患者,也可作为前列腺癌患者首选的手术方式。

Objective To evaluate the efficacy and safety of 120 W greenlight high performance system（HPS） laser for photoselective vaporization of prostate（PVP） procedure in aged high-risk patients with prostatic disease.Methods From May 2009 to Oct.2011,31 aged high-risk patients were treated with greenlight HPS laser,including 24 patients with benign prostatic hyperplasia（BPH） and 7 with prostatic cancer.The operating time,estimated blood loss,energy expenditure of laser fiber,post-operative catheterization time,complications,International Prostate Symptom Score（IPSS）,and maximum flow rate（Qmax） were recorded.Results All procedures were completed except in 2 cases.Mean operative time was（43±18.4）（ranging 30~85） min.Mean estimated blood loss was（26±10.7）（ranging 20~50） mL.NO patients needed blood transfusion.The amount of energy required was（247±38.1）kJ.Mean postoperative indwelling catheterization was（38.8±15.1）h（ranging 24~96） h.No patients suffered from incontinence,secondary hemorrhage,acute urinary retention or needed re-operation.Qmax increased form（5.2±2.7） mL/s to（15.3±4.8） mL/s,IPSS score decreased from（24.4±3.2） to（7.8±2.5）,QOL score decreased from（5.1±0.3） to（2.5±0.2）,and ROV decreased from（251.3±38.8） mL to（32.5±9.2） mL one month after operation,with significant differences between pre-and post-operation parameters（P0.05）.Conclusion HPS PVP procedures for high-risk elderly patients with prostatic disease are associated with short operative time,small amount of blood loss,increased safety,decreased complications and rapid recovery.HPS PVP procedures should be considered the first choice for high-risk elderly patients with BPH as well as with prostatic cancer.