120W绿激光前列腺汽化术在不同BPH患者群体间的疗效及安全性分析

Effect and safety of Green Light HPS 120-W laser vaporization of the prostate for different benign prostatic hyperplasia populations

目的:对比研究120 W绿激光前列腺汽化术(PVP)在不同良性前列腺增生(BPH)患者群体中的疗效及安全性。方法:对2013年7月至2014年9月于我科诊断为BPH并行120 W PVP的患者,按前列腺体积(PV)(<80 ml和≥80 ml)、有无服用5-α还原酶抑制剂(5-ARIs)(持续时间>1个月)以及有无既往急性尿潴留史(AUR)进行分组对照研究,观察记录术前及围手术期情况,并于术后1、3个月随访。结果:共174例患者纳入研究,38例患者术中转为经尿道前列腺电切术(TURP),其余136例患者顺利完成手术并随访至术后3个月。患者年龄(69.4±7.7)岁,术前PV(67.9±29.8)ml,手术时间(49.4±16.3)min。术中无输血、电切综合征及前列腺包膜穿孔发生,术后2例患者发生尿道狭窄、2例患者出现膀胱颈口挛缩。各组患者的术后疗效指标均较术前显著提高,且各对照组间(大体积前列腺组与非大体积前列腺组、5-ARIs服用组与5-ARIs未服用组、AUR病史组与无AUR病史组)无统计学差异。结论:120 W PVP治疗BPH安全有效,且疗效不受PV、术前是否规律服用5-ARIs、既往有无AUR史影响,但术前留置导尿管可能增加手术难度及术中中转TURP的风险。

Objective： To evaluated the safety and effect of the 120-W Green Light HPS laser photoselective vaporization of the prostate（ PVP） in different BPH populations. Methods： This study included 174 BPH patients treated by PVP using 120-W GreenLight HPS laser. According to the prostate volume（ PV）（ 80 or ≥80 ml）,history of 5-alpha reductase inhibitor（ 5-ARI） medication,and history of acute urinary retention（ AUR）,we divided the patients into a PV 80 ml,a PV≥80 ml,a 5-ARI,a no 5-ARI;an AUR,and a no AUR group. We collected the baseline,perioperative,and follow-up data about the patients and compared them among different groups. Results： The patients were aged 69. 4 ± 7. 7 years,of whom PVP was successfully performed for 136 and PVP was intraoperatively converted to transurethral resection of the prostate（ TURP） in the other 38,with a mean operation time of（ 49. 4 ± 16. 3） min. The preoperative PV averaged（ 67. 9 ± 29. 8） ml. There was no intraoperative blood transfusion,transurethral resection syndrome,or capsule perforation. Bladder neck contracture occurred in 2 cases and urethral stricture developed in another 2postoperatively. All the patients showed a significant improvement in the prostatic function parameters and no significant differences were observed between the PV 80 ml and PV≥80 ml,5-ARI and no 5-ARI,or AUR and no AUR groups. Conclusion： PVP with120-W Green Light HPS laser is safe and efficient for the treatment of BPH and the its effect is not influenced by the prostate volume,history of 5-ARI medication,or history of AUR. However,preoperative urinary catheterization may increase the difficulty of surgery and the risk of conversion to TURP.