高功率直出式绿激光汽化剜除术治疗良性前列腺增生症的疗效分析

Clinical effect of high power front-firing greenlight laser vapo-enucleation on benign prostate hyperplasis

目的探讨高功率直出式绿激光汽化剜除术治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的安全性及有效性。方法选取2016年4月至2018年1月北京协和医院收治的35例BPH患者,年龄54~89岁,平均70岁。均行直出式绿激光剜除术,记录手术时间、手术剜除的前列腺体积、术中及术后并发症,术后住院时间以及术后留置尿管时间,并记录术后1个月的国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量指数(quality of life,QOL)及最大尿流率(maximum flow rate,Qmax)。结果前列腺体积54.00~160.00 ml,平均(70.93±27.59)ml;总前列腺特异抗原(total prostate specific antigen,T-PSA)4.21(0.76,14.65)μg/L。术前IPSS 15~35分,平均(22.89±5.12)分;QOL评分4~6分,平均(5.37±0.69)分;平均Qmax(7.90±3.80)ml/s。所有患者手术均成功,无中转开放手术。平均手术时间(106.57±29.90)min,平均切除前列腺体积(48.03±15.39)ml。2例早期病例术中出现包膜穿孔。无严重出血病例,无经尿道前列腺电切综合征发生,无尿管堵塞发生。术后导尿管留置时间2~7 d,平均(3.03±1.54)d;术后住院时间2~7 d,平均(3.83±1.42)d。1例术后出现短期尿失禁,2周后恢复控尿。术后病理回报均符合BPH。术后1个月IPSS及QOL评分均较术前明显下降,Qmax较术前明显提高(P均<0.05)。术后随访6~18个月,无复发病例。结论高功率直出式绿激光汽化剜除术治疗BPH安全有效,值得进一步积累经验研究其临床价值。

Objective To study the safety and efficacy of high power front-firing greenlight laser vapo-enucleation on benign prostate hyperplasis(BPH).Methods A total of 35 patients with BPH from April 2016 to January 2018 were enrolled in the study.The mean age was 70 years old.All the patients accepted greenlight laser vapo-enucleation of prostate.Clinical date of all the patients were recorded,including operating time,volume of the excisional prostate,complications,postoperative length of hospital stay and catheterization time.The international prostate symptom score(IPSS),quality of life(QOL)and mean maximal urine flow rate(Qmax)were recorded after one month.Results The prostatic volume was 54-160 ml with an average of(70.93±27.59)ml,and the total prostate specific antigen(T-PSA)was 4.21(0.76,14.65)μg/L.IPSS was22.89±5.12,QOL was 5.37±0.69,and Qmax was(7.90±3.80)ml/s respectively.All operations were successful and no case was turned to open operation.The mean operative time was(106.57±29.90)min,the volume of the excisional prostate was(48.03±15.39)ml.Prostatic capsula perforation occurred in two early cases.No serious hemorrhage,transurethral resection syndrome(TURS)and catheter obstruction occurred.The mean catheterization time was(3.03±1.54)d,the mean postoperative hospital stay was(3.83±1.42)d.One case occurred temporary urinary incontinence and finally recover in two weeks after operation.The postoperative pathology results were all BPH.IPSS,QOL and Qmax after one month of operation significantly improved than those before operation(P<0.05).After six to 18 months follow up,there was no recurrence.Conclusions High power front-firing greenlight laser vapo-enucleation of prostate is a safe and effective therapy for BPH patients,which is worth of studying its clinical value.