1470 nm激光顺行法前列腺剜除术治疗前列腺增生

Technique and efficacy of 1470 nm diode laser antegradeenucleation of the prostate for benign prostatic hyperplasia

目的报告1470 nm激光顺行法前列腺剜除术治疗前列腺增生的手术技巧和临床疗效。方法 2016年9月至2017年1月我院采用600μm光纤1470 nm直出激光行顺行法前列腺剜除术共治疗30例前列腺增生患者。年龄53~86岁,平均(72±9)岁;前列腺体积27~120 ml,平均(54±25)ml。先在膀胱颈5、7点切割至包膜并延伸至精阜近端1 cm处,气化中叶后沿两侧叶下缘切割至包膜并分别延伸至3、9点,于12点膀胱颈至尿道外括约肌内侧纵行切开至包膜,沿12点处包膜分别向下行左、右侧叶顺行剜除。>80 ml腺体用组织粉碎器取出,<80 ml腺体分段气化切割。结果手术时间(65±14)min,中位出血量[M(QR)]10(15)ml。术后中位住院日4(3.8)d,留置尿管2~8 d,平均(4.5±1.5)d。术前、术后血红蛋白浓度为(129±23)g/L和(125±20)g/L,血钠浓度为(141±3)mmol/L和(140±3)mmol/L,P值均>0.05。术前IPSS和QOL评分为(22±6)和(5.2±0.7),最大尿流率(7.8±2.1)ml/s;术后1个月时IPSS和QOL评分为(8±3)和(1.9±0.9),最大尿流率(17.2±3.9)ml/s,P值均<0.05。随访1~4个月,中位随访时间2.3(2.8)个月,随访期间无尿失禁或尿道狭窄等并发症。结论经尿道1470 nm激光顺行法前列腺剜除术治疗良性前列腺增生症安全、有效,术后恢复快。该术式操作简便规范、易推广。

Objectives To present the surgical technique of 1470 nm diode laser antegrade enucleation of the prostate for benign prostatic hyperplasia （BPH） and evaluate its clinical efficacy. Methods 30 consecutive patients with BPH who underwent transurethral 1470 nm diode laser antegradeenucleation of the prostate at our institution from September 2016 to January 2017 were reviewed. The mean age of the patients was （72±9） years （range 53 to 86 years）, and the prostate volume was （54±25） ml （range 27 to 120 ml）. All procedures had been accomplished with antegrade approach： Firstly, two grooves deep into the capsule were created from bladder neck to 1 cm proximalto verumontanum at 5 and 7 o＇ clock direction. After the median lobe was vaporized, the distal margin of prostate was deepened to the capsule plane and extended to 9 and 3 o＇ clock position. Then the adenoma at 12 o＇ clock were vaporized to expose the capsule from the bladder neck to the proximal urethral sphincter. Subsequently, two lateral lobes were enucleated along the capsule with antegrade approach, respectively. The adenoma 〉80 ml were sucked by tissue morcellator and the adenoma 〈80 ml were vaporized segmentally. Results The mean operation time was （65±14） min, and the median estimated blood loss [M（QR）] was 10 （15） ml. The median postoperative hospital stay and mean duration of catheterization were 4 （3.8） d and （4.5_±1.5） d （range 2 to 8 d）, respectively. Preoperative and postoperative mean hemoglobin and serum sodium concentration were （129±23） versus （125±20） g/L and （141 ±3） versus （140±3） mmol/L, respectively, where the differences were not statistically significant. The mean IPSS score, QOL sore and Qmaxpreoperative and 1 month postoperative were （22±6） versus （8± 3）, （5.2±0.7） versus （1.9±0.9）, and （7.8±2.1） versus （17.2±3.9） ml/s, respectively, with significantly differences. No patient experienced postoperative complications such as incontinence or urethral stricture during a median follow-up of 2.3（2.8） months （range 1 to 4 months）. Conclusion Transurethral 1470 nm diode laser antegradeenucleation of the prostate is safe and effective for treatment of BPH which could provide rapid postoperative rehabilitation.