1470nm半导体激光前列腺外科包膜间层平面推铲式汽化剜切术治疗中小体积前列腺增生患者的尝试(附108例报告)

Clinical trials on transurethral 1470nm diode laser shovel type vapor-resection-enucleation of the prostate based on the inter-layer of surgical capsule for the treatment of BPH with small-medium volume(Report of 108 cases)

目的:探讨直出式1 470nm半导体激光前列腺外科包膜间层平面推铲式汽化剜切术(transurethral1 470nm diode laser shovel type vapor-resection-enucleation of the prostate,1 470 LS-VREP)治疗中小体积(<80ml)良性前列腺增生(BPH)临床安全性和疗效性,并对该术式作初步经验总结。方法:采用武汉奇致公司改良接触式直出式1 470nm半导体激光治疗系统,最大输出功率150W。逆向行1 470LS-VREP,基于外科包膜间层平面,最大程度化去除BPH组织,分析术前、术中、术后相关指标。结果:2016年1月~2017年6月,108例中小体积BPH患者行新术式1 470LS-VREP,均由同一专家顺利完成手术。结果显示,平均手术时间为(45.0±17.2)min;手术前后平均血红蛋白浓度减少量为(1.1±0.6)g/L,平均血清Na+减少为(1.25±0.62)mmol/L;术后平均膀胱冲洗时间为(20.5±9.2)h;术后平均留置尿管时间为(42.5±11.2)h;平均术后住院时间为(3.5±0.5)d。术后3个月复查,国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量(PVR)等指标均较术前明显改善,差异有显著统计学意义(P<0.01),国际勃起功能评分表-5(IIEF-5)较术前降低,但差异无统计学意义(P>0.05)。术中、术后并发症发生率(包括电切综合征、不可控制性出血及需再次手术、短暂性尿失禁、包膜穿孔、勃起功能障碍及术后BPH复发等)为0.93%。结论:基于前列腺外科包膜间层平面的1 470LS-VREP的尝试,结果证实其是目前治疗中小体积BPH一种安全、有效的改良新术式,值得临床推广。

Objective： To evaluate the clinical safety and efficacy of transurethral front-firing 1 470 nm diode laser shovel type vapor-reseetion-enueleation of the prostate （1 470 LS-VREP）, basing on the inter-layer of surgi- cal capsule for the treatment of BPH with prostate volume less than 80 ml, and to report the initial treatment expe- rience. Method： From January 2016 to June 2017, 108 BPH patients were treated by 1470 LS-VREP with. maxi- mum power of 150 W. The pre-, intra-and post-operative parameters were recorded. Result： All operations were successfully performed by the same expert. The mean operative time was （45.0 ±17.2） rain, post-operative mean hemoglobin concentration and serum sodium concentration decreased （ 1.1 ± 0.6） g/L and （ 1.25± 0.62） mmol/L, respectively. Mean post-operative catheter indwelling time and post-operative hospitalization time was （42.5 ± 11.2） h and （3.5±0.5） d, respectively. Compared with pre-operative IPSS, QOL, Qmax and PVR, all improved significantly after three months （P〈0.01）. But there showed no statistically significant difference in IIEF-5 after after months compared with that of pre-operation （P〉0.05）. With three months follow-up at least, the rate of the incidence of complications, including transurethral resection syndrome （TURS）, uncontrollable bleeding requi ring re-operation, incontinence, capsule perforation, erectile dysfunction and BPH recurrence was 0.93%. Con- clusion： For BPH patients with prostate volume less than 80 ml, the treatment of 1 470 LS-VREP based on the in-ter-layer of surgical capsule is safe and effective, deserving further promotion and application in clinical practice.