经尿道2 μm激光分割式汽化切除术治疗良性前列腺增生

目的 探讨经尿道2μm激光分割式汽化切除术治疗BPH的手术方法并评估其安全性和有效性.方法 应用70 W RevoLix 2μm连续激光行分割式经尿道前列腺汽化切除术110例.前列腺体积为(59.9±22.8)ml.术中首先条样分割前列腺腺体,然后块状切除前列腺组织.统计手术时间、术中出血量及收集到的腺体组织质量,术后留置尿管时间、住院时间,手术后PSA、残余尿量(PVR)、Q_(max)、IPSS及QOL等指标的变化.结果 110例手术均在硬膜外或骶管阻滞麻醉下完成.手术时间(46.6±16.8)min,腺体组织质量(11.0±3.5)g.平均术中失血量(38±8)ml,无输血病例.术后留置尿管时间(2.3±1.3)d,拔管后排尿均通畅.术后平均住院(4.2±1.6)d.随访6～12个月,血清PSA和PVR分别由术前的(3.8±0.9)ng/ml、(115.3±35.2)ml降至术后的(2.6±1.3)ng/ml、(41.6±12.7)ml;Qmax由术前(4.3±1.8)ml/s提高至术后的(14.5±3.6)ml/s.IPSS及QOL评分分别由术前的27.9±6.5、5.2±0.5降至术后的9.6±2.3、2.5±0.6;手术前后比较差异均有统计学意义(P＜0.05).2例患者分别于术后28、30 d出现继发性出血,均经保守治疗后停止.继发尿道外口狭窄2例,经扩张治疗后恢复通畅排尿.继发尿失禁1例,经保守治疗于术后6个月恢复.结论 分割式经尿道2μm激光汽化切除术治疗BPH术中解剖标志清晰,组织汽化效率高,利于分块切除,能够提高手术效率,是一种安全、有效的治疗BPH的经尿道激光手术模式.

Transurethral dividing vaporesection using the RevoLix 2 micron continuous wave laser for the treatment of benign prostatic hyperplasia

Objective To report the method of transurethral"dividing vaporesection"of pros- tate in the management of benign prostatic hyperplasia using the RevoI.ix 70 W 2 micron continuous laser,and evaluate its safety and clinical effects. Methods From August 2007 to August 2008,1 1 0 patients with obstructive BPH were treated transurethraly under epidural or sacral anesthesia using the "dividing vaporesection"technique.by which the whole prostatic gland was divided into several leaves longitudaly,then resected transversely blocks by blocks.Mean prostatic volume was(59.9±22.8) ml.Pre- and postoperative data were evaluated in operating time,blood loss.collected prostatic speci- mens,catheter-time,hospitalization time,PSA,post voiding residual volume(PVR),urinary flow rate(Qmax),international prostatic symptom scores(IPSS),and quality of life(QOL).SPSS 15.0 software was used for data analysis. Results A1l cases were treated under epidural or sacral anes- thesia.Mean operation time was(46.6±16.8)rain.Mean blood loss was(38士8)ml during the oper- ation.Mean collected prostatic specimens were(1 1.0±3.5)g and could be easily flashed out of the bladder.Mean catheter time was(2.3±1.3)d.Mean hospitalization time was(4.2±1.6)d.All cases were followed up for 6 to 12 months.Mean PSA and PVR dropped from(3.8±0.9)ng／ml to(2.65±1.3)ng／ml and from(1 15.3±35.2)ml to(41.6±12.7)ml,respectively.Mean Qmax increased from (4.3±1.8)ml／s preoperatively to(14.5±3.6)ml／s postoperatively.IPSS and QOL-Score improved from 27.9±6.5 and 5.2±0.5 to 9.6±2.3 and 2.5±0.6,respectively(P<0.05).There were 2 ca- ses with secondary bleeding and recovered under conservative managements.Two cases of external u- retbral strictures were met and treated with urethral dilatation successfully.0nly 1 case of urinary in- continence was observed and recovered 6 months later. Conclusion The method of'dividing vapore- section'of the prostate using the 2 micron laser system is a rapid,effective and safe procedure in the treatment of BPH.