微拉激光手术治疗前列腺增生的方法探讨及疗效观察

Operation method exploration and clinical effect of Vela XL laser treatment of benign prostatic hyperplasia

目的探讨微拉（Vela XL）激光手术治疗良性前列腺增生症（BPH）的方法和临床效果,并评估其安全性。方法 2013年7月-2014年4月,应用经尿道微拉激光手术治疗80例BPH。患者平均年龄（73.3±10.6）岁,前列腺术前体积平均（75.8±23.5）ml,术前IPSS评分（21.3±9.1）分,最大尿流率（Qmax）（6.9±3.8）ml/s。手术方法采用分叶整体切割法：先在5、7及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,当还有少量组织未完全离断时,用激光将左侧叶快速汽化切割成小块组织以便能冲出,同法切除右侧叶,最后切除中叶。结果手术时间平均（50.1±18.3）min,术中无明显出血,无手术并发症,无输血病例。术后导尿管留置时间平均2.6（1-3）d。术后1个月IPSS评分（6.9±2.5）分,Qmax（23.8±5.1）ml/s,与术前相比均有显著改善（-.05）。结论微拉激光具备强大的汽化切割功能和良好的止血功能,对组织的热损伤小。分叶整体切割法适用于微拉激光前列腺切除,具有切除速度快、组织切除彻底、并发症少及安全性高等优点。

【Objective】To explore operation method and observe clinical effect and safety of Vela laser for treatment of benign prostatic hyperplasia（BPH）. 【Methods】 80 BPH patients, aged（73.3 ±10.6）, with a mean prostate volume of（75.8±23.5） m L, average international prostate symptom score（IPSS） of（21.3 ±9.1） score, average maximum urinary flow（Qmax） of（6.9 ±3.8） m L/s, were treated by transurethral Vela laser resection during July 15,2013 to April 15, 2014 in our hospital with total lobe vaporesection separately. Firstly, between bladder neck and verumontanum, we cut three trenches, which located at the 5, 7, 12 point of prostate and had a width of 0.5~1 cm, a depth to surgical capsule. Then, from the 12 point, we firstly cut left lobe totally closed to the surgical capsule of prostate. When there was a little prostate tissue linked to the capsule, we vaporesected left lobe into little blocks so that it could be washed out of bladder, and the right lateral lobe and median lobe were vaporesected at the same way. 【Results】The mean operative time was（50.1±18.3） min. During these operations, the vision was clear and there was no obvious bleeding, no complications and no people required blood transfusion. The mean postoperative catheterization time was 2.6 d（1 -3 d）. One month after the operation, the IPSS was（6.9 ±2.5） and the Qmax was（23.8±5.1） m L/s, which showed significant improvement than before（P〈0.05）.【Conclusion】Vela laser system has excellent vaporization, incision and hemostasis function, and can accurately vaporesect tissue with less thermal damage. With advantages of rapid and thorough resection, less complications and high safety, the method of total lobe vaporesection is an ideal way for treatment of BPH by Vela laser.