光选择性前列腺汽化术治疗抗凝状态下良性前列腺增生的短期疗效评价

Short-term clinical evaluation of photoselective vaporization of the prostate for the patients with be-nign hyperplasia of prostate in anti-coagulanting status

目的探讨光选择性前列腺汽化术（PVP）治疗接受口服抗凝剂的良性前列腺增生（BPH）患者的有效性及安全性。方法2008年9月至2010年5月收治因心脑血管疾患长期口服华法林抗凝治疗的BPH患者7例，平均年龄74岁。不停用口服抗凝药的情况下使用100W绿激光手术系统行PVP手术。术前凝血酶原时间（13．14±O．15）s。记录患者的前列腺体积、手术用时、术中出血量、术后留置导尿时间、住院天数，并评估手术前后残余尿量（PVR）、最大尿流率（Qmax）、IPSS评分。结果手术时间（65±22）min，术中无活动性出血及输血。手术前后血红蛋白及凝血酶原时间比较差异均无统计学意义（P〉0．05）。住院天数（2．7±1．2）d。术后1个月随访，患者IPSS评分、PVR、Qmax均有显著改善（P〈0．05）。术后出现尿潴留1例，4周后顺利拔除导尿。余6例患者均未出现排尿困难、血尿等不良反应。结论PVP术具有术前无需停服抗凝药、术中出血少等特点，对接受口服抗凝治疗的BPH患者安全、有效。由于本组例数有限，还需要大样本量的随机对照研究进一步证实PVP术在持续抗凝患者中的安全性及有效性。

Objective To evaluate the safety and efficacy of the photoselective prostate vaporization （PVP） for the patients of benign hyperplasia of prostate （BPH） with oral anti-coagulant. Methods From September 2008 to May 2010, 7 cases of BPH with oral anti-coagulant were treated by PVP, with an average age of 74 years. The prothrombin time before the surgery was （13.14 ±0.15） s. An 100 W Green-light la- ser source was applied in this study. The prostate volume, operating time, blood loss, catheter indwelling time after the surgery, hospital stay, PVR, Q IPSS score were recorded. Results The mean operating time was （65 ± 22） min without active bleeding or transfusion in this cohort. The haemoglobulin concentra- tion was intact and catheter indwelling time was （22± 8） h, while the hospital stay was （2.7 ±1.2） d. The PVR, Q IPSS score were significantly improved after follow-up of 1 month （P 〈 0.01 ）. One case com- plicated acute urinary retention after operation in this cohort, and the catheter was removed 4 weeks after u- blocker administration. Conclusions PVP is a safe and effective surgical strategy for BPH patients with oral anti-eoagu｜ant. However, since there were relatively limited cases enrolled in this study, more random- ized controlled clinical trials are needed in the near future.