经尿道2μm激光前列腺汽化切除术治疗大体积良性前列腺增生的初步经验

目的 分析应用2μm激光行前列腺汽化切除术治疗大体积(＞80 g)良性前列腺增生(BPH)的临床特点.方法 大体积BPH患者45例.年龄57～88岁,平均69岁.其中伴尿潴留者9例.前列腺超声测得前列腺体积80～128 ml,平均(96±13)ml.均采用硬膜外麻醉行经尿道2 p.m激光前列腺汽化切除术.8例术中行耻骨上膀胱穿刺造瘘.术中首先贴近包膜汽化切割中叶;其次在12点处汽化切开腺体深达包膜,由膀胱颈部至精阜垂直水平,并沿包膜向卜剥离两侧叶;将精阜一侧的前列腺尖部组织沿包膜用操作鞘剜起后,再从12点处将剥离的组织向下正向切割,直至与中叶切割半面汇合.同法切割另一侧叶.遵循由内向外、由上到下的原则.观察术中出血情况、手术时间、术后尿管留置时间、排尿情况、最大尿流率及住院时间.结果 除1例因心率、血压波动大,仅完成中叶及右侧叶腺体手术外,其余均顺利完成前列腺汽化切除术.手术时间75～150 min,平均(104±12)min.无输血病例.术后留置导尿管3～5 d,1例术后3周出现前尿道狭窄,间断扩张22次后排尿通畅并稳定,余44例均排尿通畅,无尿失禁.术后随访3～12个月,平均最大尿流率由术前(3.3±0.5)ml/s增至(16.5±1.5)ml/s,国际前列腺症状评分及生活质量评分从28.6±5.5和4.5±0.4分别降至8.3±2.3和2.7±0.2,手术前后比较差异均有统计学意义(P＜0.01).术后无继发出血.结论 经尿道2 μm激光前列腺汽化切除术治疗大体积BPH是一种安全、有效的微创治疗方法,结合剜除技术能提高汽化切割效率.

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

Objective To evaluate the efficacy of the RevoLix 70 Watt 2 micron continuous wave laser vaporesection for treatment of large volume benign prostatic hyperplasia(BPH,＞80 g).Methods Forty-five patients with obstructive BPH were treated with 2 micron continuous wave laser vaporesection.The age ranged from 57 to 88 years with a mean of 69 years.Nine patients had acute urinary retention.Mean prostatic volume was(96±1 3)ml(ranged from 80 to 128 m1).Eight cases were given suprapubic puncture.All cases were successfully anesthetized by using epidural anesthesia.At the beginning of the operation,the distal resection border close to the verumontanum was marked and laser incisions were performed at 5 and 7 o'clock lithotomy position.Firstly,median lobe was vaporeseeted closely along capsule from bladder neck to verumontanum.Secondly,prostate at 12 o'clock was vaporesected until the capsule was reached,and both lateral lobes were dissected downward.Thirdly,the apical position was enucleated by sheath,and then prostate was vaporesected from the tissue in 12 o'clock position to the tissue at 6.It was important to follow the 2 principles:inner to extra,up to down.Transfusion rate,resection time,time of indwelling catheter,improvement in urinary flow rate(Qmax),international prostate symptom score(IPSS)and quality of life(QOL)were measured.Results AIl cases were successfully operated.except one whose left lateral lobe was left due to heavy fluctuation of heart rate and blood pressure in operation.The mean operation time was (104±12)min.Transfusions were not necessary in any patients.The catheter was indwelled for 3 to 5 d postoperatively.One case had urethral stricture 3 weeks after operation,and urinated free after 22 times urethral sounding disj unctively.All cases were followed up for 3-1 2 months.All patients were satisfied with voiding outcome,none had incontinence.Mean Qmax increased from(3.3±0.5)ml/spreoperatively to(16.5±1.5)ml/s postoperatively.IPSS decreased from 28.6±5.5 to 8.3±2.3 and QOL score decreased from 4.5±0.4 to 2.7±0.2.respectively(P＜0.01).No hemorrhage occurred after the operation.Conclusion RevoLix 2 micron continuous wave laser vaporesection for treatment of large volume BPH is a safe and effective relief therapy,and that in combination with enucleation could improve the efficiency of vaporesection.