双波长半导体激光“分叶整体切割法”治疗前列腺增生的疗效评估

Dual-wavelength diode laser system in treatment of benign prostatic hyperplasia with total lobe vaporesection separately

目的：探讨经尿道双波长半导体激光系统（CeralasHPD）治疗良性前列腺增生（BPH）的手术方法和临床效果，并评估其安全性。方法：2013年1月25日-2013年6月25日期间，应用经尿道CeralasHPD手术治疗51例BPH。患者平均年龄（69．5±7．3）岁，前列腺术前体积平均（73．5±17．7）ml，术前IPSS评分（20．4±7．3）分，最大尿流率（Qmax）（7．2±3．4）ml／s。采用“分叶整体切割法”，先在5、7、12点处分别切开一沟槽，内至膀胱颈，外不超过精阜，宽约0．5～1．0cm，深达外科包膜，然后从12点处开始，贴近包膜整体切除左侧叶，再切除右侧叶，最后切除中叶。结果：手术时间平均（51．2士19）min，术中无明显出血，手术过程中视野清晰，无手术并发症，无输血病例。术后导尿管留置时间平均2．7（1-3）d。术后1个月IPSS评分（7．0=k2．3）分，最大尿流率Qmax（24．3±5．6）ml／s，与术前相比均有显著改善（P〈0．05）。结论：CeralasHPD能高精度地切割组织，同时具备强大的汽化功能和良好的止血功能，对组织的热损伤小。双波长半导体激光“分叶整体切割法”前列腺切除术具有切除速度快，组织切除彻底，并发症少，安全性高等优点，是一种较理想的前列腺切除方法。

Objective： To evaluate the clinical efficacy and safety of dual-wavelength diode laser system for treatment of benign prostatic hyperplasia （BPH）. Method： Fifty-one BPH patients were treated by transurethral dual-wavelength diode laser system from Jan. 2013 to Jun. 2013 in our hospital with method of total lobe vapore- section separately. The clinical data of the patients were as follows., the average age of the patients was （69.5±7.3） years old the mean prostate volume was （73.5±17.7） ml; the average preoperative international prostate symptom score （IPSS） was （20.4±7.3） ; the average maximum urinary flow （Qmax） was （7.2±3.4） ml/s. First- ly, between bladder neck and verumontanum, we cut three trenches with width of 0.5--1.0 cm and depth to sur- gical capsule, which located at 5, 7, 12 point of prostate. Then, from the point 12, we separately cut left and right lateral lobes and median lobe totally, closed to the surgical capsule of prostate. Result： The mean operative time was （51.2±19） rain. During these operations, the vision was clear and there were no obvious bleeding, no complications and no blood transfusion. The mean postoperative catheterization time was 2.7 （range, 1- 3） d . One month after the operation, IPSS score was （7.0±2.3） and Qmax was （24.3±5.6） ml/s. The above results showed significant improvement compared with preoperative condition （P〈0.05）. Conclusion： Dual-wavelength diode laser system has excellent vaporization and hemostasis function, and can accurately resect tissue with less thermal damage. With advantages of rapid and thorough resection, less complications and high safety, the method of total lobe vaporesection separately is an ideal way for treatment of BPH by dual-wavelength diode laser.