2μm激光汽化切除术治疗前列腺增生的临床研究

目的探讨2μm激光汽化切除术治疗前列腺增生（BPH）的安全性和疗效。方法应用70W2μm连续波医用激光对70例BPH患者行2μm激光汽化切除术。患者年龄65～84,72.6±4.7岁。经直肠前列腺超声测得前列腺体积80～128ml,平均96±13ml。观察记录手术时间、术后留置尿管时间、手术并发症,记录并统计分析手术前后国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）及剩余尿量（PVR）等指标的差异有无统计学意义。结果全部手术均成功,手术时间平均（80.2±16.9）min,术中无明显出血,无输血病例。术后平均留置尿管时间2.4±0.3d。术后随访3个月,IPSS及QOL评分由术前平均27.9±4.6及4.9±0.6分别下降至5.7±2.0及1.3±0.8,Qmax由术前6.2±2.0ml/s增加至术后18.4±1.9ml/s,PVR由术前118.4±60.0ml下降至术后22.3±9.9ml,手术前后比较差异均有统计学意义（P〈0.01）。40例术前仍保持性功能者,术后均保留性功能。术后无尿失禁发生。结论 2μm激光汽化切除术治疗良性前列腺增生症安全有效,尤其适合于高龄、高危患者,但对其长远疗效还需进一步观察。

Two micron continuous wave laser vaporesection for the treatment of benign prostatic hyperplasia

Objective To evaluate the safety and efficacy of two micron continuous wave laser vaporesection for the treatment of benign prostatic hyperplasia（BPH）.Methods Seventy patients with obstructive BPH were treated with the RevoLix 70 Watt 2 micron continuous wave laser vaporesection.The age ranged from 65 to 84 years with a mean of 72.6±4.7 years.Mean prostatic volume was 96±13 ml（ranged from 80 to 128 ml）.The operative time,indwelling catheterization and operative complications were observed.The variables such as IPSS,QOL,Qmax,PVR were recorded and calculated pre-and post-operatively.Results The two micron continuous wave laser vaporesection was successfully performed on all the 70 patients with BPH.The mean operative time was 80.2±16.9 min.No significant bleeding was found during operation and no patients required blood transfusion.The average postoperative catheter time was 2.4±0.3 days.All cases were followed up for 3 months.IPSS and QOL scores decreased from preoperative 27.9±4.6 and 4.9±0.6 to postoperative 5.7±2.0 and 1.3±0.8,respectively,Qmax increased from 6.2±2.0 ml/s to 18.4±1.9 ml/s,and PVR decreased from 118.4±60.0 ml to 22.3±9.9 ml.There were significant differences of these parameters between pre-and post-operation（P0.05）.The 40 patients with preoperative sexual function still remained potent sexual function after operation.No urinary incontinence occurred.Conclusion Two micron continuous wave laser vaporesection of the prostate is a safe and efficient procedure in treatment of BPH,especially for those at advanced age or at high risk.Longer follow-up is needed to prove the durability of these promising results.