经尿道2微米激光汽化切除术治疗良性前列腺增生症5年随访结果

5-year follow-up to transurethral vaporesection of the prostate using the 2 micron continuous wave laser for the treatment of benign prostatic hyperplasia

【目的】探讨经尿道2 μm激光汽化切除术治疗良性前列腺增生症（BPH）的安全性和有效性。【方法】2006年10月至2007年9月间应用70 W 2 μm激光治疗BPH患者236例，排除有前列腺或尿道手术病史，合并神经源性膀胱功能障碍以及手术后被证实为前列腺癌者，210例纳入本组研究。手术采用经典的U形分块切除或“分割式”切除方法。记录患者基本情况及手术操作时间、收获的前列腺组织质量、输血率，术后留置尿管时间、住院时间，手术前后最大尿流率（Qmax）、国际前列腺症状评分（IPSS）、生活质量评分（QoL）及残余尿量（PVR）的变化。术后随访时间为5年。【结果】本组共179例患者获得5年随访。全部手术均在硬膜外或全身麻醉下完成。平均手术时间为（80±22）min（42～146 min），平均收获腺体组织质量为（24.9±4.2）g（15.3～32.6 g）。被切除的前列腺组织块可通过切除镜鞘顺利吸出。全部患者手术前后血钠浓度及血红蛋白水平均无明显变化。3例患者拔除尿管后因残留的已经被切除的前列腺组织块阻塞而发生急性尿潴留，经再次激光汽化切除并置管引流处理于1周后恢复。术后平均留置尿管时间及平均住院时间分别为（114±35）h、（5.7±1.9）d。术后继发出血并输血治疗1例。至随访结束，患者平均Qmax由术前的（8.6±3.5）ml/s增加至（23.6±4.2）ml/s（P〈0.01），IPSS及QoL评分由术前的25.3±5.2、4.1±1.3恢复至6.1±3.0、1.4±0.8（P〈0.01），PVR由术前的（248±89）ml降至（15±13）ml。3例患者术后继发尿失禁，经功能锻炼及针灸治疗3个月后康复。5例患者继发尿道狭窄，分别接受尿道扩张（3例）或尿道内切开（2例）治疗。【结论】2 μm激光能够安全、有效地汽化切除良性增生的前列腺腺体，术后3个月起患者的排尿困难显著改善，能够在为期5年的长期随访中表现出持久而稳定的疗效。

Objective To summarize the 5-year follow-up to 2 micron continuous wave laser vaporesection for the treatment of patients with low urinary tract symptoms （ LUTS ） secondary to benign prostatic hyperplasia （ BPH）, and evaluate the safety and clinical effects of the treatment. Methods From October 2006 to September 2007, 236 cases with low urinary tract symptom secondary to BPH were treated transurethrally under epidural or general anesthesia using the 70 Watt 2 micron laser system. Vaporesection of the prostate was performed with the traditional ＂U＂ or the ＂dividing＂ method. The 210 cases who met the inclusion criteria in this study were selected for further observation. Baseline and perioperative data were recorded and evaluated in resection time, transfusion rate, catheter-time, improvements in maximal urinary flow rate （Qmax）, international prostate symptom scores （IPSS）, quality of life （QoL）, and post voiding residual volume （PVR）. Results Out of the 210 cases, 179 cases were followed up to 5 years finally. All the surgical procedures were successfully conducted under epidural or general anesthesia. Mean operation time was （80 ± 22） minutes, and mean retrieved prostatic tissue was （24. 9 ±4.2） g. Resected prostatic tissues could be easily flashed out of the bladder. There were no significant differences in serum sodium concentrations and hemoglobin levels before and after the surgery. Mean catheter time and hospital stay was （ 114 ± 35 ） hours and （ 5.7 ± 1.9 ） days respectively. Only one postoperative secondary hemorrhage was found and treated with blood transfusion. During the 5-year follow-up, Qmax increased from （ 8.6 ± 3.5 ） ml/s preoperatively to （23.6 ± 4. 2） ml/s by the end of the follow-up （ P 〈 O. O1 ）, IPSS and QoL-Score improved from 25.3 ±5.2 and 4. 1 ± 1.3 to 6. 1 ± 3.0 and 1.4 ±0. 8 respectively （P 〈0. 01）, and PVR decreased from （248 ± 89） ml to （ 15 ± 13 ） mL The 3 patients developed urinary incontinence and recovered 3 months later through functional exercises with the help of acupuncture. Five patients were found to have urethral stricture 3 months after the surgery and recovered with the treatment of urethral dilatation （ 3 cases） or internal urethrotomy （2 cases） respectively. Conclusions Transurethral vaporesection of prostate using the 2 micron continuous wave laser system is a safe and effective treatment for benign prostatic hyperplasia with obvious improvements in subjective and objective voiding parameters, which were evident at 3 months after the surgery and were sustained throughout the 5-year long-term follow-up.