经尿道国产1470nm激光汽化术治疗<30g小体积前列腺增生的临床体会

目的探讨经尿道国产1470nm激光汽化术治疗<30g小体积前列腺增生患者的安全性、有效性和远期并发症情况。方法回顾性研究2017年10月至2018年9月我院45例<30g小体积前列腺增生患者的临床资料,其中TURP组20例,1470 nm激光组25例。详细记录两组患者的临床资料、围手术期并发症和随访情况。结果45例患者手术均成功,术后平均随访时间12.6个月(9~16个月)。两组患者年龄、前列腺体积和IPSS、RUV、Qmax和QOL基线资料差异无统计学意义(P>0.05)。TURP组和1470 nm激光组患者术后3个月IPSS、RUV、Qmax和QOL均较术前改善(P<0.05),组间比较差异无统计学意义(P>0.05)。1470 nm激光组患者手术时间([48.6±13.6)min vs(56.8±11.7)min,P=0.038]、术后膀胱持续冲洗时间[(0.8±0.5)d vs(1.5±0.9)d,P=0.001]、导尿管留置时间([2.7±0.6)d vs(4.7±0.9)d,P<0.001]和住院时间([4.2±1.2)d vs(5.2±1.9)d,P=0.036]较TURP组患者明显缩短,术前术后血红蛋白浓度变化更小([5.5±2.4)g/L vs(11.6±2.7)g/L,P<0.01]。随访发现TURP组有2例出现尿道狭窄,1470 nm激光组无尿道狭窄病例发生。结论经尿道国产1470 nm激光汽化术治疗<30 g小体积前列腺增生安全有效,与传统TURP比较术中出血少,术后恢复时间更短,无尿道狭窄并发症发生,为BPH的个体化治疗提供了新的思路。     

Thulium fiber laser lithotripsy: an in vitro analysis of stone fragmentation using a modulated 110-watt Thulium fiber laser at 1.94 microm

BACKGROUND AND OBJECTIVES: The high-power Thulium fiber laser has previously been shown to rapidly vaporize and coagulate soft urinary tissues (e.g., prostate). This is the first preliminary study of a high-power Thulium fiber laser for fragmentation of urinary stones. STUDY DESIGN/MATERIALS AND METHODS: A continuous-wave, high-power Thulium fiber laser operating at a wavelength of 1.94 microm, was modulated to operate in pulsed mode with an output pulse energy of 1 J through a 300-microm-core silica fiber at a 20 milliseconds pulse length and repetition rate of 10 Hz. The fragmentation time to reduce uric acid (UA) (n = 13) and calcium oxalate monohydrate (COM) (n = 6) stones into particles < 2 mm was measured. RESULTS: Mean initial mass of the UA and COM stones measured 860+/-211 and 763 +/- 204 mg. Fragmentation rates measured 388 +/- 49 and 25 +/- 2 mg/minute. Average time needed to fragment the UA and COM stones into particles < 2 mm was 2.25 +/- 0.63 and 30.7 +/- 8.4 minutes, respectively. CONCLUSIONS: The high-power Thulium fiber laser, when operated in pulsed mode, is capable of fragmenting both soft (UA) and hard (COM) urinary stones. The Thulium fiber laser may be useful as a single laser system for use in multiple soft and hard tissue laser ablation applications in urology.     

Endoscopic Vaporesection of the Prostate Using the Continuous-Wave 2-μm Thulium Laser: Outcome and Demonstration of the Surgical Technique

Background

The potential of a new continuous-wave (CW) 70-W, 2.013-μm thulium-doped yttrium aluminium garnet (Tm:YAG) laser for the endoscopic treatment of benign prostatic hyperplasia (BPH) is investigated.

Objective

The simultaneous combination of vaporisation and resection of prostatic tissue in a retrograde fashion is the main characteristic of this new laser technique. We provide a DVD that shows the main steps of this procedure.

Design, setting, and participants

We retrospectively evaluated 56 nonconsecutive patients who were treated by thulium laser vaporesection of the prostate in our institution between 2005 and 2007.

Surgical procedure

Vaporesection of the prostate is performed by moving the fibre semicircumferentially from the verumontanum towards the bladder neck, thereby undermining tissue and cutting chips.

Measurements

Blood loss, postvoiding residual urine (PVRU), maximum flow rate (Q_max), and the International Prostate Symptom Score (IPSS) were measured as well as prostate volume and prostate-specific antigen (PSA). The duration of the procedure, need for postoperative irrigation, duration of catheterisation, and hospital stay were recorded.

Results and limitations

The median procedure time was 60 min, postoperative irrigation was necessary in 19 out of 56 patients, and the median duration of catheterisation was 23 hr. At the day of discharge, the mean haemoglobin value decreased by 0.2 mg/dl (p = 0.13), the average Q_max improved from 8.1 to 19.3 ml/s (p < 0.001), and the PVRU decreased from 152 ml to 57 ml (p < 0.05). The blood transfusion rate was 3.6%, and two patients needed a recatheterisation postoperatively (3.6%). After a median follow-up of 9 mo, the IPSS improved from 19.8 at baseline to 8.6 (p < 0.001). Four patients had a repeat transurethral resection of the prostate (TURP) during the learning curve, but this was not necessary in any of the later patients. One patient developed a urethral stricture, and another developed a bladder neck contracture.

Conclusions

The thulium laser seems to be a suitable tool for the endoscopic treatment of BPH.     

2μm激光在经尿道膀胱肿瘤切除术中的应用

目的探讨2μm激光治疗膀胱肿瘤的手术方法和优势。方法采用RevoLix2μm激光手术系统治疗膀胱肿瘤137例,其中单发肿瘤109例,多发肿瘤28例,肿瘤直径2～35 mm,135例肿瘤病理为膀胱移行细胞癌,G1～G3,临床分期T1～T2。结果所有手术顺利完成,手术时间5～35min,术中出血量0～10 ml,均未出现膀胱穿孔、水中毒、尿外渗、术后大出血,并于24 h内即刻膀胱灌注化疗,并维持膀胱灌注化疗。术后尿管留置3～5 d,术后住医院3～5 d,术后随访3～31个月,无手术区复发。结论 2μm激光手术系统经尿道治疗T2期内膀胱癌安全有效。其与经尿道膀胱肿瘤电切术比较,在术中操作及避免并发症方面有一定优势。     

Potential of a new cw 2 μm laser scalpel for laparoscopic surgery

The potential of a new continuous-wave (cw) thulium–YAG laser for laparoscopic small intestine resection was investigated in pigs in comparison to standard bipolar scissors.

Method

A diode-pumped solid-state thulium–YAG laser system emitting at a wavelength of 2.01 μm was used. Laser power up to 25 W in cw mode was transmitted via a quartz fibre (400 μm core diameter). In order to resect 1 m of the small intestine, the accompanied mesentery was dissected with both devices in 12 pigs (six each group). Arteries and veins of 0.25–3.2 mm inner diameter were dissected in vivo and the resistance of the occluded vessels to pressures up to 375 mmHg was measured by an in vitro set-up. Samples were prepared for histological evaluation.

Results

With respect to intestine resection with bipolar scissors, bleeding occurred significantly less (25%) and dissection time was reduced by 19% using the 2 μm laser scalpel. With the 2 μm laser scalpel, small vessels (<0.5 mm) were successfully occluded up to 100% (arteries) and 89% (veins), larger vessels (1–2.3 mm) to 74% (arteries) and 65% (veins) in vivo. In the in vitro pressure measurement with 375 mmHg, 30% of veins and 35% of arteries stayed closed. In conclusion, the first experiments show that the 2 μm laser scalpel is a promising dissection device for minimally invasive surgery.     

Laser treatment of benign prostatic obstruction: basics and physical differences

Context

Laser treatment of benign prostatic obstruction (BPO) has become more prevalent in recent years. Although multiple surgical approaches exist, there is confusion about laser-tissue interaction, especially in terms of physical aspects and with respect to the optimal treatment modality.

Objective

To compare available laser systems with respect to physical fundamentals and to discuss the similarities and differences among introduced laser devices.

Evidence acquisition

The paper is based on the second expert meeting on the laser treatment of BPO organised by the European Association of Urology Section of Uro-Technology. A systematic literature search was also carried out to cover the topic of laser treatment of BPO extensively.

Evidence synthesis

The principles of generation of laser radiation, laser fibre construction, the types of energy emission, and laser-tissue interaction are discussed in detail for the laser systems used in the treatment of BPO. The most relevant laser systems are compared and their physical properties discussed in depth.

Conclusions

Laser treatment of BPO is gaining widespread acceptance. Detailed knowledge of the physical principles allows the surgeon to discriminate between available laser systems and their possible pitfalls to guarantee high safety levels for the patient.     

经尿道1.9μm铥激光膀胱肿瘤切除术的疗效与安全性分析

目的 以经尿道等离子汽化膀胱肿瘤切除术(transurethral plasma kinetic resection of bladder tumor, TUPKBt)为对照,分析经尿道1.9 μm铥激光膀胱肿瘤切除术(thulium laser resection of bladder tumor, TmLRBt)的疗效与安全性.方法 比较72例分别行TUPKBt及经尿道1.9 μm TmLRBt患者术中、术后的相关指标.所有患者随机分为TUPKBt组(n=35)和TmLRBt组(n=37).结果 两组患者的性别、年龄、肿瘤特点比较差异无统计学意义.TUPKBt组发生闭孔神经反射4例,TmLRBt组未发生闭孔神经反射.TUPKBt组需要进行膀胱冲洗患者比例为45.7%(16/35)、留置尿管时间(3.5±0.8)d. TmLRBt 组需要膀胱冲洗患者比例为18.9%(7/37)、留置尿管时间(2.2±0.7)d.术后平均随访18(4~25)个月.两组均无复发.结论 TmLRBt治疗膀胱安全有效,手术并发症及术后恢复时间优于TUPKBt.     

The influence of isotopic and nonisotopic carriers on the biodistribution and biokinetics of M3+-citrate complexes

The influence of carrier amounts of Fe, Ga, and Tm on the biodistribution of ⁶⁷Ga-, ⁵⁹Fe-, and ¹⁶⁷Tm-citrate in mice was investigated. Our results suggest that ¹⁶⁷Tm, unlike ⁶⁷Ga and ⁵⁹Fe, is not transported by transferrin in the blood. Of the three radioisotopes tested, ¹⁶⁷Tm had the highest tumor/background ratio (10 h after the injection). The application of Fe carrier led to an enhancement of the elimination of ⁶⁷Ga from the blood and muscles, resulting in a better tumor/background ratio.