高功率绿激光汽化术治疗良性前列腺增生的临床应用

Evaluation of high power greenlight HPS laser for photoselective vaporization of prostate in the treatment of benign prostatic hyperplasia

目的探讨160 W绿激光选择性前列腺汽化术(PVP)治疗良性前列腺增生(BPH)的效果及手术技巧。方法对34例BPH患者进行PVP。对手术时间、出血量、术后留置导尿时间、并发症、最大尿流率、国际前列腺症状评分(IPSS)、QOL等指标进行评价。结果 3例因前列腺两侧叶超出精阜平面较多,在前列腺尖部残留组织形成活瓣,改用电切镜修整前列腺尖部,使之平坦;其余31例顺利完成手术。平均手术时间为(57.51±11.43)min。平均出血量为(34.12±9.25)m L。所有患者无前列腺包膜穿孔,无输血,无电切综合征发生,无死亡病例。术后平均留置导尿管时间为(3.15±0.44)d,术后平均住院时间为(3.47±0.75)d。1例拔除导尿管后排尿困难,再次留置导尿管并使用α受体阻滞剂治疗后治愈。无尿失禁、继发性出血病例。术前IPSS评分为(29.38±0.55)分,术后平均为(5.21±0.33)分;QOL术前平均为(4.29±0.12)分,术后平均为(1.53±0.10)分;术前最大尿流率Qmax平均为(5.97±0.33)m L/s,术后平均为(17.29±0.37)m L/s;手术前后差异有统计学意义(P<0.05)。结论 160 W绿激光PVP治疗良性BPH,具有手术时间短,出血少,安全性高,术后并发症少,留置导尿管时间短等优点。尤其适用于高龄高危良性BPH患者。处理前列腺尖部时要求操作者有较熟练的经验。

Objective To evaluate the efficacy and operative skills of 160 W greenlight high performance system ( HPS) laser for photoselective vaporization of prostate ( PVP) in the treatment of benign prostatic hyperplasia ( BPH) . Method PVP was used in 34 pa-tients with BPH. We evaluated the variables of operative time, amount of bleeding, postoperative persistent time of catheter, complication, maximun flow rate, IPSS and QOL. Results Surgery was finished easily in 31 patients. The other 3 patients were altered to resectoscope in repairing the head of prostate because of too much hyperplasia above verumontanum surface and forming valve in the head. The average opera-tive time was (57. 51 ± 11. 43)minutes. The average amount of bleeding was (34. 12 ± 9. 25)mL. there wasn’t any complications of prostat-ic capsula perforation, needs of blood infusion, transurethal resection syndrome, and death. The average time of postoperative catheter was ( 3.15 ±0.44 )days. The average inpatient time was( 3.47 ±0.75 )days. One patient with dysuria after removing catheter was given re-placement of catheter and аreceptor blockers and cured. No patient had urinary incontinence and secondary bleeding. IPSS grade was (5. 21 ±0.33) after operation compared to (29.38 ±0.55) before operation;the average QOL was (1.53 ±0.10 )decreasing from (4.29 ±0.12);and average of maximun urine flow rate was (17. 29 ± 0. 37 ) mL/s, increasing from (5. 97 ± 0. 33) mL/s. All these had significant difference (P<0. 05). Conclusions 160 W greenlight HPS laser for PVP in the treatment of BPH had the advantages of short operative time, small a-mount of bleeding, high safety, fewer complications, and less catheter time. It can be especially used in older and high risk BPH patients.