经尿道Urobeam940nm半导体激光前列腺剜除术腔内解剖性微创治疗BPH(40例报告)

Transurethral Enucleation and Resection of the prostate by Urobeam 940nm Diode Laser(40 cases report)

目的:介绍40例经尿道Urobeam940nm半导体激光剜除术腔内微创治疗BPH的初步经验,探讨其安全性、有效性。方法:2011年6月～2012年3月,由具有丰富的TURP操作经验并熟练掌握腔内剜除术的专家教授对40例患者行经尿道Urobeam940nm半导体激光前列腺剜除术。统计患者术前的一般情况、围手术期情况及术后随访情况。结果:40例手术均成功完成。患者年龄(69.00±9.61)岁,合并高血压病15例、冠心病3例、脑血管意外4例、心律失常2例、肾功能不全2例、COPD 2例、糖尿病9例,2例患者术前2天停用阿司匹林、波立维。术前患者前列腺体积(71.74±37.43)ml,IPSS(22.50±5.74)分,QOL(4.32±0.76)分,最大尿流率(10.47±1.27)ml/s,残余尿量(15.95±29.58)ml,PSA(4.29±2.35)ng/L,术前、术后Hb和Na+分别为(129.45±12.41VS 120.32±16.36)g/L,(141.17±2.70VS 138.19±4.25)mmol/L,术中包膜穿孔2例(5%),无1例输血,未发生死亡、TURS、膀胱损伤、直肠损伤、闭孔神经反射等术中并发症。手术时间(44.60±9.30)min,其中剜除时间(19.42±4.77)min,组织粉碎时间(25.17±5.26)min,膀胱冲洗时间(21.92±3.71)h,留置尿管时间(27.50±7.96)h,术后住院时间(4.95±0.95)天。术后1个月时随访,IPSS、QOL、Qmax、PVR分别为:(5.87±1.81)分、(1.65±0.53)分、(19.69±2.22)ml/s、(4.07±12.75)ml;3个月时随访,IPSS、QOL、Qmax、PVR分别为:(5.37±1.51)分、(1.35±0.48)分、(20.92±2.11)ml/s、(1.25±3.10)ml。随访3个月,短暂性尿失禁3例(7.5%),尿道膀胱刺激征激光组5例(12.5%),术后均未出现拔除尿管后尿潴留、长期尿失禁、尿道狭窄、继发性出血等并发症。结论:经尿道Urobeam940nm半导体激光腔内剜除术BPH安全、有效,是未来BPH腔内微创治疗的新趋势。

Objective： To introduce the preliminary experience of Transurethral Enucleation and Resection of the prostate by Urobeam940nm Diode Laser and evaluate the feasibility,safety of this surgery.Methods： 40 BPH patients underwent Transurethral Enucleation and Resection of the prostate by Urobeam940nm Diode Laser by sophisticated surgeons from June 2011 to March 2012.We collect the data of the general conditions of preoperation、 preoperative and follow-up of these patients.Results： All the 40 cases of operation were successfully completed.General conditions of preoperation：age（69.00 ±9.61） years old,15 cases with hypertension,3cases with coronary heart disease,4cases with cerebrovascular accident,2cases with arrhythmia,2cases with renal dysfunction,2cases with COPD,9cases with diabetes,2cases stoped aspirin and Plavix 2days before the operation.Preoperative prostate volume（71.74±37.43ml）,IPSS（22.50±5.74）,QOL（4.32±0.76）,Qmax（10.47±1.27） ml / s,PVR（15.95±29.58ml）,PSA（4.29±2.35） ng / L.Preoperative and postoperative hemoglobulin and serum sodium were（129.45±12.41VS 120.32±16.36） g / L,（141.17±2.70VS 138.19±4.25） mmol / L.Intraoperative complications ： Two（5%） of patients in laser group suffered from prostatic capsule perforation,no transfusion was required and all enrolled patients were free of other complications like TURS,bladder or rectum injuries,obturator nerve damage and death.Perioperative indicators ： Operation time（44.60±9.30） min,Enucleation time（19.42 ±4.77） min,morcellation time（25.17±5.26） min,bladder douche time（21.92±3.71） h,catheterization time（27.50±7.96） h,postoperative hospitalization time（4.95±0.95） days.Conditions of follow-up ： IPSS,QOL,Qmax and PVR a month after surgery were（5.87±1.81）、（1.65±0.53）、（19.69±2.22） ml / s 、（4.07±12.75） ml and three months after surgery were（5.37±1.51）、（1.35±0.48）、（20.92±2.11） ml / s 、（1.25±3.10） ml.three patients（7.5%） presented with short period of incontinence and five（12.5%） with urinary tract irritation;No case of urinary retention,long-term incontinence,urethral stricture,or secondary bleeding was observed in three months of follow-up.Conclusions ： The research indicates that Transurethral Enucleation and Resection of the prostate by Urobeam 940nm Diode Laser is safe and effective,it may be a new trend in minimally invasive treatment of BPH.