1470nm激光六步法前列腺分叶剜除术治疗良性前列腺增生症(附46例报告)

Clinical efficacy of 1 470nm diode laser enucleation of the prostate via divided lobes by six steps(Report of 46cases)

目的：报告采用1 470nm激光六步法行经尿道前列腺分叶剜除术（DioLEP）方法,治疗良性前列腺增生症的临床疗效。方法：2015年3～10月我院采用550～600μm的1 470nm激光直出光纤行前列腺分叶剜除术。患者46例,年龄（75.3±5.8）岁,有前列腺相关下尿路症状病史（4.2±3.3）年,前列腺重量为（83.3±27.2）g。手术时先从膀胱颈5点、7点处汽化切割,制备两条沟槽,从膀胱颈延伸至精阜前方。从精阜前方掀背式剜除前列腺中叶。在12点处由膀胱颈至尿道外括约肌内侧纵行切一条槽沟,分别剜除左侧叶和右侧叶腺体,推入膀胱。汽化修整创面及前列腺尖部,并彻底止血。用组织粉碎器粉碎组织后吸出。结果：所有手术顺利完成,手术时间为（73.5±21.1）min,术中出血量大约为（5～60）ml,无输血病例。术后膀胱冲洗时间为（1.4±0.6）d,留置导尿管时间为（3.7±1.5）d,术后住院时间（6.3±2.3）d。患者均能顺利排尿,无继发性出血发生。8例患者术后有一过性尿急症状,经对症处理能好转。2例患者活动时少许漏尿发生,经凯格尔运动等对症处理3个月后好转。所有患者随访3～10个月,IPSS评分及生活质量评分明显下降（P〈0.01）,术后最大尿流率和剩余尿明显改善（P〈0.01）。结论：采用1 470nm激光六步法前列腺分叶剜除术是一种高效、安全有效的治疗良性前列腺增生症手术方法。

Objective：To report the clinical efficacy of 1 470 nm diode laser enucleation of the prostate（DioLEP）via divided lobes by six steps.Method：From March to October 2015,we treated 46 BPH cases by transurethral enucleation of prostate via divided lobes with 1 470 nm laser by a 550-600μm end-firing laser fibre.Patients were（75.3±5.8）years old,who had medical history of prostate-associated lower urinary tract symptoms（4.2±3.3）years,and their prostate weight were（83.3±27.2）g.At first,we cut two grooves from bladder neck to the forward of verumontanum at five and seven o＇clock direction.And then we lifted the middle lobe of the prostate as a whole from the forward of verumontanum to bladder neck.We cut gouge from bladder neck to the inside of the urethral sphincter longitudinally at 12o＇clock.After identifying the plane at the surgical capsule,the left lobe and right lobe adenoma were separated from the capsule by stripping the adenoma from the capsule and moved into the bladder,respectively,just similarly to open operation.We trimmed wound and tip of the prostate by vaporization with end-firing laser fiber and controlled the active bleeding.All adenoma tissues in bladder were sucked out after being morcellated.Result：All the operations were completed successfully.The operation time was（73.5±21.1）min,and intraoperative blood loss was about 5-60 ml.No cases needed blood transfusion.Bladder irrigation period after operation was（1.4±0.6）d,urethral catheter indwelling time was（3.7±1.5）d,and postoperative hospital stay was（6.3±2.3）d.All patients urinated smoothly after being pulled out the catheter.No secondary hemorrhage occurred.Eight patients experienced transient urinary urgency after operation and soon improved by symptomatic treatment.Two patients suffered from mild incontinence during moving,and improved by Kagel exercise three months later.All patients were followed up for 3-10 months,which revealed a significant reduction in IPSS and QOL（P〈0.01）and improvement in Q maxand RUV（P〈0.01）as compared with those preoperative data.Conclusion：It is a safe and effective treatment for BPH by DioLEP via divided lobes with 1 470 nm diode laser straight optical fiber.