选择性绿激光汽化术治疗良性前列腺增生五年随访分析

Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia： Five- year follow-up outcomes

目的总结选择性绿激光汽化术治疗良性前列腺增生的疗效及术后各种并发症的原因及其处理方法。方法回顾性分析2004年8月至2006年7月间经随访达5年的278例选择性绿激光汽化术治疗的良性前列腺增生患者的临床资料，包括术前及其术后第5年的国际前列腺症状评分（IPSS），生活质量评分（QOL），最大尿流率（Qmax），前列腺特异性抗原（PSA），残余尿（RUV）及其随访长期并发症和处理等。结果所有患者术后第5年的IPSS、QOL、Qmax、PSA、RUV均较术前明显改善（P〈0．01）。随访5年中出现残留腺体复发再次入院手术17例，尿道狭窄8例，膀胱颈挛缩6例，迟发出血5例，尿路感染4例，前列腺癌2例，均经过相应治疗后满意恢复。结论选择性绿激光汽化术治疗良性前列腺增生是前列腺增生的有效治疗方法，其改善效果持续可靠。残留腺体复发、尿道狭窄、膀胱颈挛缩、血尿等是其主要并发症，均可针对不同病因得到良好治疗。

Objectives To evaluate the effects of greenlight photoselective vaporization of the prostate（PVP） in the treatment of benign prostatic hyperplasia and summarize the causes and management of postoperative complications. Methods A retrospective analysis was performed in 278 benign prostatic hyperplasia patients undergoing the PVP treatment from August 2004 to July 2006. The baseline and 5-year evaluations included international prostate symptom score （ IPSS）, quality-of-life measures （ QOL）, prostate- specific antigen （ PSA）, maximal flow rate （ Qmax）, residual urine volume （ RUV ）, late complications and corresponding treatment. Results There was significant improvement in IPSS, QOL, Qmax,PSA and RUV at the 5th year after treatment（P 〈 0.01 ）. During the 5 years＂ follow-up, 17 patients were treated with re- peated PVP because of reobstruction due to residual prostatic hyperplasia, 8 patients had urethral stricture, 6 had bladder neck contracture, 5 had delayed bleeding,4 had urinary tract infection and 2 had prostate carcinoma. All patients were satisfied with therapeutic efficacy after treatment. Conclusion The results of this study have established the long-term durability of PVP for the treatment of benign prostatic hyperplasia with obstruction, demonstrating sustained clinical effects. The main complications include residual prostatic hyperplasia,urethral stricture, bladder neck contracture and hematuria. Best therapeutic approach should he chosen accordin~ to different causes of the late complications after PVP.