国产半导体激光前列腺剜除术在日间手术中的初步应用经验

Preliminary experience of domestic diode laser transurethral enucleation of the prostate in day surgery

目的:观察国产980 nm半导体激光经尿道前列腺剜除术对于选定患者进行日间手术的安全性及有效性。方法:我院于2019年8月~2020年4月期间完成了48例经过严格筛选的前列腺增生患者,并予行日间980 nm半导体激光经尿道前列腺剜除术。所有患者均在门诊行术前检查。纳入标准包括麻醉评估满足日间手术要求,术前B超估算前列腺体积40~120 mL,总前列腺特异性抗原(TPSA)水平0~4μg/L,具有强烈的手术意愿。术后密切观察患者各项生命体征,符合出院标准的患者予以出院。术后1周及术后1个月门诊复查,专人收集临床相关资料并进行分析。结果:48例前列腺增生症患者均顺利完成日间980 nm激光剜除术,无严重并发症发生,未有转入普通住院患者。平均手术时间为(60.2±4.92) min,术后血红蛋白下降平均值为(10.5±3.19)g/L,术后血钠下降平均值为(1.77±0.38) mmol/L,术后平均膀胱冲洗时间为(8.00±1.62) h。39例患者术后12 h内拔除尿管,9例患者因术中发现挛缩前列腺及包膜炎性等改变而延长留置尿管至60 h。无严重血尿需再次处理患者。术后出现急迫性尿失禁患者3例,其中2例选择口服M受体阻滞剂药物治疗,1例选择继续观察,并适时的盆底肌功能锻炼,1个月内门诊随访均获得满意控尿。结论:利用国产980 nm半导体激光进行日间经尿道前列腺剜除术,疗效安全可靠。日间手术模式治疗前列腺增生,可加快周转,符合现代医院快速康复的管理理念,建议在高通量医疗中心开展,期待更大样本量和设计更为合理的随机对照研究来证实其效果。

Objective: To observe the safety and effectiveness of domestic 980 nm diode laser transurethral enucleation of the prostate in selected patients for day surgery. Method: From August 2019 to April 2020, 48 strictly screened patients with benign prostatic hyperplasia underwent daytime 980 nm diode laser transurethral enucleation of the prostate. All patients underwent preoperative examination in the outpatient clinic. The inclusion criteria include anesthesia assessment to meet the requirements of day surgery, preoperative ultrasound estimation of prostate volume of 40-120 mL, total PSA level of 0-4 μg/L, and a high necessity of surgery. The vital signs of the patients were closely observed postoperatively and the patients who met the discharge standards were discharged immediately. The outpatient review was performed one week after the surgery the first time and one month after the surgery the second time, both with clinical data being collected and analyzed. Result: All patients were successfully completed the day surgery without serious complications or transfer to ordinary inpatients. The mean operation time was(60.2±4.92) min with(8.00±1.62) h postoperative irrigation time. The average postoperative hemoglobin decrease was(10.5±3.19) g/L, and the postoperative blood sodium decrease was(1.77±0.38) mmol/L. Of all the patients, thirty-nine had the catheter removed within 12 hours after surgery and nine patients had the indwelling urinary catheter for a prolonged 60 hours due to the contracture of the prostate and inflammatory changes in the capsule intraoperatively. No severe hematuria needs reoperation. There were three patients who suffered from urge incontinence after operation. Two of them chose oral drug treatment, and the other one chose continuing observation and pelvic floor muscle exercise timely. Finally all patients were satisfied with urinary control during outpatient follow-up within 1 month. Conclusion: The use of domestic 980 nm diode laser for daytime transurethral enucleation of the prostate is safe and reliable. The treatment of prostate hyperplasia by day surgery mode can speed up the turnover. It is in line with the concept of enhanced recovery after surgery in modern hospitals. It is recommended to be carried out in high-volume centers. A larger sample size and well designed randomized controlled study is expected to confirm its effect.