层面递进法激光腔内剜除高危前列腺增生的治疗体会

Experiences in the treatment of high-risk prostatic hyperplasia by laser intracavitary extirpation with hierarchical method

目的探讨1470 nm激光剜除治疗高危前列腺增生的手术技巧及临床效果。方法回顾分析2018年6月至2018年9月中山大学附属第三医院泌尿外科采用1470 nm激光治疗共89例高危前列腺增生患者的临床资料,年龄平均(68±3)岁,前列腺体积(57.4±2.6)ml。所有患者均采用"寻找层面,先易后难,剜切结合"的层面递进法思路行激光腔内前列腺剜除术,比较患者术中及术后情况。结果89例均顺利完成手术,与术前相比,术后3个月患者最大尿流率明显增加,[(6.9±2.1)ml/s vs(19.8±3.6)ml/s]。国际前列腺症状评分显著好转,[(24.6±1.7)vs(8.0±1.2)]。术中无输血、无电切综合征、无直肠和膀胱穿孔病例,无输尿管损伤、大出血、心脑血管意外等严重并发症发生。结论层面递进法激光剜除技术构想对于高危前列腺增生外科包膜层面的寻找、减少术后并发症有独到优势,且易于掌握,或可为业界同行提供一个新的思路。

Objective To investigate and evaluate the clinical effect and safety of intracavitary laser surgery with the hierarchical technique for high-risk prostate hyperplasia patients.Methods The modified surgery was performed on 89 cases of high risk prostate hyperplasia patients in the Third Affiliated Hospital of Sun Yet-Sen University.All the clinical data were analyzed retrospectively,The average age of the patient was(68±3)years,the average prostate volume was(57.4±2.6)ml.All patients underwent laser intracavitary prostate enucleation with the hierarchical approach,which is"Look for layers,easy first,difficult later,resect and enucleate",and their intraoperative and postoperative conditions were compared.Results All 89 procedures were performed successfully.The maximum urine flow rate(Qmax)were improved from(6.9±2.1)ml/s to(19.8±3.6)ml/s,and the international prostate symptom score(IPSS)were significantly decreased from(24.6±1.7)to(8.0±1.2),3 months after surgery.No patient required transfusion.Transurethral resection syndrome,rectum and bladder perforation,and ureteral injury,massive bleeding,cardiovascular and cerebrovascular accidents and other serious complications were not occurred during the operation.Conclusion The laser exorsion surgery with hierarchical method has unique advantages in finding the capsule level and reducing postoperative complications of high-risk prostatic hyperplasia.It is easy to grasp and may provide a new method for colleagues.