经尿道直出绿激光推铲式汽切术治疗高龄高危良性前列腺增生的临床分析

Clinical analysis of transurethral end-fire greenlight photoselective vaporesection of prostate-shovel technique for the treatment of elderly and high-risk patients with benign prostatic hyperplasia

目的评估经尿道直出绿激光前列腺推铲式汽切术(greenlight photoselective vaporesection of the prostate-shovel technique,PVRP-ST)治疗高龄高危良性前列腺增生(benign prostatic hyperplasia,BPH)的安全性和疗效。方法应用120W直出绿激光行PVRP-ST治疗50例高龄(≥80岁)高危BPH患者,观察平均手术时间、留置导尿管时间、膀胱冲洗时间、手术并发症,比较手术前后血钠离子(Na+)、钾离子(K+)、血红蛋白(hemoglobin,Hb)浓度及红细胞压积(hematocrit,HCT)的改变,随访患者术后3个月的国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life,QOL)、最大尿流率(maximum flow rate,Qmax)和残余尿量(residual urine volume,RUV)。结果全部患者手术顺利,术中无严重并发症。手术时间平均为(68.2±23.8)min,术中出血量平均为(4.5±1.9)ml,留置导尿管时间平均为(38.6±8.1)h,膀胱冲洗时间平均为(17.6±8.3)h。术后3个月,IPSS及QOL评分由术前平均(20.3±3.1)及(4.5±0.9)分分别下降至(4.9±2.4)及(1.2±0.5)分,Qmax由术前(7.7±3.9)ml/s增加至术后(16.7±4.5)ml/s,RUV由术前(96.4±124.5)ml下降至术后(6.8±9.3)ml,手术前后比较差异均有统计学意义(P<0.05),而术后血Na+、K+、Hb浓度及HCT的改变与术前比较差异无统计学意义(P>0.05)。结论经尿道直出绿激光PVRP-ST治疗高龄高危BPH安全、有效。

Objective To evaluatethe the safety and efficacy of transurethral end-fire green- light photoselective vaporesection of prostate-shovel technique （PVRP-ST） for high-risk and elderly patients with benign prostatic hyperplasia （BPH）. Methods A total of 50 high-risk and elderly pa- tients with BPH were underwent PVRP-ST. The operative time, catheter indwelling time, bladder irrigation time and operative complications were observed. The variables such as sodium （Na＋ ） concentration, potassium ions （K＋ ） concentration, hemoglobin （Hb） concentration, and hematocrit （HCT） were compared before and after operation. International prostate symptom score （IPSS）, quality of life （QOL）, maxmium flow rates （Qmax）, residual urine volume （RUV） before and 3 months after operation were compared. Results All operations were successfully completed and no severe complication occurred. The mean operative time was （68.2±23.8）min, average amount of bleeding was （4.5±1.9） ml, mean catheter indwelling time was （38.6 ± 8.1 ） h and mean bladder irrigation time was （17.6 ±8.3） h. Three months after the operation, IPSS and QOL scores decreased form preoperative （20.3±3.1） and （4.5±0.9） to postoperative （4.9±2.4） and （1.2±0.5） respectively. Qmax increased from （7.7±3.9）ml/s to （16.7±4.5）ml/s, and RUV decreased from （96.4±124.5）ml to （6.8±9.3） ml. There were significant differences of these parameters between preoperation and postoperation （P 〈0.05）. There were not significant differences in values of Na＋ ,K＋ ,Hb,HCT between preoperation and postoperation （P〉0.05）. Conclusions The transurethral end-fire PVRP-ST is a safe and efficient procedure for high-risk and elderly patients with BPH.