经尿道钬激光剜除前列腺的临床分析与总结

CLINICAL ANALYSIS OF TRANSURETHRAL HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HoLEP)

目的 :分析钬激光剜除前列腺 (HoLEP)治疗前列腺增生症的临床疗效及并发症的防治。方法 :骶麻下使用美国科以人公司提供的大功率 1 0 0W钬激光器以及组织粉碎器对 1 50例前列腺增生患者进行经尿道前列腺剜除与前裂腺组织粉粹。结果 :一次手术成功 1 50例 ,手术时间 (2 0～ 78) 50min ,组织粉碎时间 (5～ 90 )2 8min ,获得前列腺组织重量为 (2 5～ 78) 58.8g(67.8% ) ,术后继发出血 3例 ,膀胱损伤 6例 ,尿道狭窄 4例 ,术后改开放手术 1例 ,无尿失禁 ,无闭孔神经反射 ,无水中毒。Qave9.3～ 3 .6ml/s(术前 ) ,1 8～ 2 9ml/s(术后 ) ,P<0 .0 1。I-PSS评分达优、良、中三组标准达 1 0 0 %。结论 :钬激光剜除前列腺疗效可靠 ,出血少 ,速度快 ,且可直达列腺外科包膜 ,术后呈TURP通道 。

Objective:To study the effect of Holmium laser enucleation of the prostate on benign prostatic hypertrophy and its' provention and treatment of complications.Methods:Under the caudal anesthesia, by means of urethro, 150 patients with benign prostatic hyperplasia were treated by transurethral high-power 100W Holmium laser and morcellator provided for Coherent Lnc. in America.Results:The operation was successful in 150 patients.The time of enucleation operation was (20～78)50min. The time of tissue morcellation was (5～90)28min. The tissue weight of prostate which was enucleated and morcellated was (25～76)58.5g (67.8%). There were 3 postoperative patients with secondary bleeding, 6 patients with bladder injury, 4 patients with urethrostenosis, 1 patient with being changed into openning operation,and no patient with incontinence of urine, without leflex of obturator nerve,without water-poisoning.All the patients got normal micturition after the urethral catheter being draw (0.66 ～4)1.5 days alter, and got following-up for 2～12months. Qave 9.3～3.6ml/s(preoperation), and Qave 18～29ml/s (postoperation),( P <0.01). Symptomatic scores (I-PSS)exceeded to middle grade in 100% patients. Conclusion:The effect of the Holmium laser enucleation of the prostate were reliable and safe.The incision was fast with low bleeding. Holmium laser enucleating prostate can reach onto the circular fibers of the prostate capsule. Postoperation shew TURP passage. It was suitable for advanced aged and patients with critical diseases.