选择性绿激光前列腺汽化术治疗良性前列腺增生症疗效观察

Follow-up observation of photoselective vaporization of prostate for treatment of benign prostatic hyperplasia within five years

【目的】评价选择性绿激光前列腺汽化术（PVP）治疗良性前列腺增生症（BPH）的5年内疗效及安全性。【方法】2004年12月至2009年12月间，行PVP手术治疗的BPH患者782例，均已除外神经源性膀胱功能障碍及前列腺癌者，记录患者手术情况及术后随访资料，随访截止时间为术后5年。【结果】782例患者中740例手术一次完成，42例手术分2次进行。平均手术时间（85±38）min，消耗激光能量（355±124）kJ。术后留置尿管时间及术后住院时间分别为（2.3±1.7）d和（5.2±2.6）d。围手术期未出现严重并发症患者。术后平均随访时间（44±19）个月（6～60个月），有效随访时间达5年的患者398例，其术后5年时国际前列腺症状评分、生活质量评分、最大尿流率和残余尿量分别为12.8±6.9、2.2±1.6、（14.5±2.4）ml/s、58 ml（M50），与术前比较差异均有统计学意义（t=－18.3、－11.7、38.3，Z=－15.5，P＜0.05）。前列腺增生复发再手术率2.3%（9/398），尿道狭窄及膀胱颈挛缩发生率分别为1.5%和0.5%。【结论】PVP术能有效持续改善前列腺增生患者主客观排尿参数，其手术并发症少、再手术率低。

Objective To evaluate the efficacy and safty of photoselective vaporization of prostate （PVP） in the treatment of benign prostatic hyperplasia with obstruction within 5 years. Methods From December 2004 to December 2009, there were 782 cases have been except for neurogenic bladder dysfunction and prostate cancer, who received PVP surgical treatment of BPH. The surgical conditions and postoperative follow-up data were recorded and the follow-up cut-off time for surgery after 5 years. Results A total of 782 patients with BPH who underwent PVP were included in this retrospective study. The operation in 740 cases was successfully completed at one time. But in other 42 cases, the twice operation was performed. The mean operation time was （85 ± 38 ） minutes, and the mean energy delivery was （355 ± 124） kJ. The mean catheterization and postoperative hospitalization time was （2. 3 ± 1.7） days and （5.2 ± 2. 6） days, respectively. No severe intraoperative complications were observed. The mean follow-up was （44. 1 ± 19. 3 ） months. The shortest follow-up was 6 mouths. The longest follow-up was 5 years. Complete follow-up data were available for 398 of the 782 patients. Of the 398 patients followed up for 5 years, the mean international prostate symptom score after 5 years was 12. 8 ± 6.9, quality of life score was 2. 2 ± 1.6, maximal flow rate was （14. 5 ±2.4） ml/s, and residual urine volume was 58 ml （3/5o）. The retreatment rate because of BPH was 2. 3% （9/398）. Urethral stricture and bladder neck contracture were observed in 1.5% and 0. 5% of the patients, respectively. Conclusions PVP has demonstrated remarkably consistent results for objective and subjective voiding parameters. Its late complication is rare and retreatment rate is lOW.