1470nm半导体激光前列腺剜除术灌注液吸收临床观察

Preliminary study of absorption of irrigation fluid occurs during 1470nm diode laser enucleation of the prostate

目的 探讨经尿道1470 nm半导体激光前列腺剜除术中灌注液吸收的手术方式安全性.方法 分析2016年7月至2016年10月在本科应用1470 nm半导体激光剜除术治疗前列腺增生患者20例,术中使用含有1％乙醇等渗盐水作为灌注液,监测患者呼出气乙醇浓度,计算灌注液吸收量.结果 手术时间30～160 min,平均（56.2±32.3）min,灌注液使用量9～48 L,平均（17.1±9.6）L,10例患者监测到灌注液吸收,吸收量为2089 mL,20例患者术前血红蛋白平均（133.8±14.4）g/L,术后24 h平均（121.2±18.7） g/L,差异具有统计学意义（P=0.000）,其中测得灌注液吸收患者血红蛋白下降较未吸收者显著,手术前后血钾、钠差异无统计学意义（P＞0.05）,术中发生静脉窦明显开放3例,包膜穿孔2例,其中1例患者在手术结束时出现烦躁、呼吸急促,测算灌注液吸收量为7240 mL,考虑发生灌注液吸收综合征,迅速予以面罩吸氧、利尿等处理,病情逐渐稳定.全部病例获随访3个月,3例短期尿失禁2个月内自愈,IPSS、QOL、Qmax、PVR较术前明显改善,差异有统计学意义（P＜0.05）.结论 经尿道1470 nm半导体激光前列腺剜除术疗效确切,但术中存在一定比例的灌注液吸收,尤其对于心肺功能不全的患者,术中应加强灌注液吸收量与血流动力学的监测.

Objective To investigate absorption of irrigation fluid occur during 1470 nm diode laser enucleation of the prostate,and evaluate the safety of the operation.Methods We retrospectively analyzed the clinical data about 20 cases of benign prostate hyperplasia （BPH） treated by 1470 nm diode laser enucleation from July 2016 to October 2016.Intraoperative use of isotonic saline contained 1% ethanol as irrigation fluid,breath ethanol concentration of patients was observed,and irrigation fluid absorption was calculated.Results The operation time was 30-160 min,average（56.2 ±32.3）min,irrigation fluid volume was 9-48 L,average（17.1 ±9.6） L,absorptive amount of Irrigation fluid absorption was 2089 mL in 10 cases.There was no significant difference in serum potassium or serum sodium before and after surgery of 20 patients,preoperative haemoglobin was （133.8 ± 14.4） g/L,haemoglobin in postoperative 24 h was （121.2 ± 18.7）g/L.Postoperative hemoglobin was decline （P =0.000）,especially postoperative hemoglobin of patients with irrigation fluid absorption was significantly decline.Three cases of sinus open and two cases prostate capsule perforate occurred during operation.One of them was happened dysphoric and shortness of breath at the end of the operation.Twenty patients were followed up for 3 months,which revealed that 3 patients with urinary incontinence in two months healing and significant reduction in IPSS and improvement in Qmax and PVR （P 〈 0.05）.Conclusions Transurethral enucleation of the prostate using 1470 nm diode laser is an effective method.But there is a certain proportion of irrigation fluid absorption,especially for patients with cardiopulmonary insufficiency,intraoperative monitoring has a necessity.