经尿道选择性绿激光汽化术治疗大体积良性前列腺增生症

目的总结80W绿激光汽化术治疗大体积良性前列腺增生症的技术及临床疗效。方法回顾性分析2007年9月2009年11月完成经尿道80W绿激光汽化术治疗体积〉100mL良性前列腺增生症患者围手术期及随访资料,包括术前前列腺体积、血红蛋白、国际前列腺症状评分（IPSS）、生活质量（QOL）评分,手术时间、汽化激光能量及术后血清钠、血红蛋白、术后留置尿管时间、IPSS、QOL评分、3个月后残余前列腺体积等。结果 45例体积〉100mL的良性前列腺增生症患者均在持续硬膜外麻醉下完成手术,无中转开放手术。术前前列腺体积（128.82±24.82）mL,血红蛋白（138.5±6.85）g/mL,IPSS评分27.10±2.88,QOL4.26±0.87,术前最大尿流率（6.53±3.76）mL/s,手术时间（141.00±30.19）min,汽化能量（36.14±11.64）MJ,术后3d血红蛋白（124.33±7.64）g/mL,术后留置尿管时间（101.55±20.55）h,术前与术后血清钠无明显变化,血红蛋白轻度下降,无需输血。3个月后残余前列腺体积（44.63±10.31）mL,IPSS评分11.58±2.52,QOL2.74±1.10。无尿道狭窄发生。结论经尿道80W绿激光汽化术治疗体积〉100mL的良性前列腺增生症,具有良好的安全性和临床疗效,可作为此类患者的首选治疗之一。

Transurethral Photoselective Vaporization of the Prostate with Large-Volume Benign Prostate Hyperplasia

Objective To investigate the efficacy and safety of 80Watt high-power potassium-titanyl-phosphate （KTP）photoselective laser vaporization of the prostate（PVP）in patients with large-volume benign prostate hyperplasia（100mL）.Methods Retrospective analysis was performed in patients with large-volume benign prostatic hyperplasia（100mL）,who were treated with the 80Watt KTP transurethral photoselective laser vaporization of the prostate from September 2007to November 2009.The preoperative evaluation included prostate volume by transrectal ultrasonic scanning,serum sodium and serum hemoglobin,international prostate symptom score（IPSS）and quality of life（QOL）score.The operative time and vaporization energy and average indwelling catheterization time were recorded.The postoperative serum sodium,serum hemoglobin after the operation were compared with those before the operation.After 3months,the IPSS,QOL and residual prostate volume were evaluated.Results Forty-five patients of totally 219patients with100mL prostate in volume were successfully operated under continuous epidural anesthe-sia.None was changed to open operation.The mean preoperative prostate volume was（128.82±24.82）mL,the mean IPSS was（27.10±2.88）and QOL were（4.26±0.87）.The mean operative time was（141.00±30.19）minutes.The mean indwelling catheterization was（102.17±19.50）hours.The serum sodium did not change,while the serum hemoglobin level reduced mildly but without transfusion.After 3month,the mean IPSS was（11.58±2.52） and QOL were（2.74±1.10）with residual prostate volume was（44.63±10.31）mL.No stricture was observed in this group.Conclusion The transurethral photoselective vaporization of the prostate with 80Watt KTP laser is a safe and effective therapy for patients with100mL prostate in volume in experienced PVP center.