经尿道钬激光前列腺剜除术治疗良性前列腺增生

目的 :评价经尿道钬激光前列腺剜除和前列腺组织粉碎术治疗良性前列腺增生 (BPH)的临床效果。　方法 :应用 10 0W钬激光器和组织粉碎器对 35例BPH病人实施经尿道钬激光剜除和前列腺组织粉碎术治疗。　结果 :本组 35例手术均获成功。手术时间 30～ 180min ,平均 (6 0 .0± 2 3.2 )min。获得前列腺组织 10～ 5 6g ,平均(31± 9) g ,术后留置导尿管时间 2 0h～ 4d ,平均1.5d。无术中术后输血病例。组织病理学诊断均为BPH。 32例获随访 ,术后 3个月随访国际前列腺症状评分 (IPSS)由 (2 4.0± 6 .2 )分降至 (5 .6± 3.6 )分 (P <0 .0 0 1)。最大尿流率 (Qmax)由 (8.5± 3.9)ml/s上升至 (2 2 .0± 7.2 )ml/s(P <0 .0 0 1) ,残余尿由 (138± 12 5 )ml减少到 (2 1± 15 )ml,未发生严重并发症。　结论 :钬激光前列腺剜除术是治疗BPH的有效微创方法 ,术中术后出血少 ,能够完整剜除增生的前列腺组织。留置导尿管时间短 ,临床症状改善明显。     

经尿道前列腺钬激光剜除术治疗良性前列腺增生的疗效研究

目的：观察经尿道前列腺钬激光剜除术（holmiumlaserenucleationoftheprostate,HoLEP）治疗良性前列腺增生的临床疗效及安全性。方法应用100W钬激光和组织粉碎器对480位良性前列腺增生症的患者行经尿道钬激光前列腺剜除术和组织粉碎术。分别记录患者术前、术中及术后随访的临床资料,分析及评估HoLEP的疗效及安全性。结果480例手术均成功,手术时间25～240min,平均（76．1±39．2）min,切除腺体15～320g,平均（45．8±15．4）g。术后留置导尿48～216h,平均（72．5±23．2）h,术后膀胱持续冲洗时间0～48h,平均（23．6士11．2）h,术后住院时间3～15d,平均（3．36±1．25）d,血红蛋白平均降低（1．1±0．5）g／dL。术后IPSS、QOL、Qmax、PVR较术前明显改善（P〈0．01）。术后并发症率低。结论经尿道前列腺钬激光剜除治疗良性前列腺增生疗效安全可靠,并发症少,剜除彻底,并且适应范围广,有可能挑战TURP成为治疗BPH的新的金标准。     

良性前列腺增生合并轻度尿道狭窄的治疗

本文回顾性分析我院收治的21例良性前列腺增生(BPH)合并轻度尿道狭窄患者的临床资料。21例行前列腺手术时, 先行尿道扩张或尿道内切开。12例行经尿道前列腺钬激光剜除术(HoLEP),术后3例出现严重尿道狭窄而接受再次手术, 9例排尿通畅;4例逆向射精;2例暂时性尿失禁。9例行腹腔镜前列腺剜除术, 术后均排尿通畅, 无严重尿道狭窄、暂时性尿失禁和逆向射精。腹腔镜前列腺剜除术治疗合并轻度尿道狭窄的BPH较HoLEP能降低尿道狭窄的风险。     

经尿道钬激光前列腺剜除术治疗前列腺增生

目的评价经尿道钬激光前列腺剜除和前列腺组织粉碎术治疗良性前列腺增生（BPH）的临床效果,探讨手术操作技巧及并发症的预防。方法应用100 W钬激光器和组织粉碎器对45例BPH患者实施经尿道钬激光前列腺剜除（HoLEP）和组织粉碎术。术前国际前列腺症状评分（IPSS）为15-32分,平均24.0分,最大尿流率（Qmax）为4-15 mL/s,平均8.4 mL/s,膀胱残余尿为60-246 mL,平均115 mL。结果41例行HoLEP手术成功。手术时间50-200 min,平均105 min,获得前列腺组织30-85 g,平均48.6 g,其中输血5例,膀胱黏膜或膀胱壁损伤5例,尿失禁1例,尿道狭窄3例。保留导尿时间3-7 d,平均4.3 d。术后35例获随访3个月,IPSS降至3-10分,平均5.2分（P〈0.01）,Qmax升至18-25 mL/s,平均22.4 mL/s（P〈0.01）,膀胱残余尿为0-68 mL,平均26 mL（P〈0.01）。结论经尿道钬激光剜除前列腺组织损伤小,术中出血少,并发症少,疗效可靠。HoLEP学习曲线较长,应注意手术技巧的掌握,减少并发症的发生。     

比较经尿道前列腺汽化电切术与经尿道前列腺钬激光剜除术治疗良性前列腺增生症的效果

目的比较经尿道前列腺汽化电切术与经尿道前列腺钬激光剜除术治疗良性前列腺增生(BPH)的效果。方法将45例BPH患者根据手术方式分为2组,汽化组(22例)给予经尿道前列腺汽化电切术,钬激光组(23例)实施经尿道前列腺钬激光剜除术。比较2组手术时间、术中出血量、膀胱冲洗时间、留置尿管时间及并发症发生情况。结果钬激光组术中出血量、膀胱冲洗时间、留置尿管时间均低于汽化组;术后排尿困难、出血、尿道狭窄并发症发生率低于汽化组。差异均有统计学意义(P0.05)。结论经尿道钬激光剜除术治疗BPH,创伤小、并发症发生率低、患者术后康复快。     

钬激光前列腺剜除术与电切术安全性及疗效比较

目的 比较并探讨钬激光前列腺剜除术(HoLEP)和传统经尿道前列腺电切术(TURP)的安全性及疗效,旨在为良性前列腺增生症的临床治疗提供理论依据.方法 回顾性分析哈尔滨医科大学附属第四医院2015年1月-2016年1月收治的349例良性前列腺增生症患者的病例资料,并将其随机分成两组.其中172例患者选择行钬激光前列腺剜除术,另外177例患者选择行传统经尿道前列腺电切术.比较两组患者术中出血量、手术时间、术后导尿管留置时间、术后住院天数以及术后并发症(尿失禁、膀胱痉挛、出血)的发病率.随访3个月,重新评估IPSS、QOL、Qmax指标并比较疗效.结果 与传统经尿道前列腺电切术组相比,钬激光前列腺剜除术组患者的手术时间明显缩短、术中出血量及术后住院天数显著降低(P＜0.05),术后导尿管留置时间[钬激光前列腺剜除术组:(2.4±0.5)d;传统经尿道前列腺电切术组:(5.7±0.6)d,P＜0.05].明显减少,术中切除前列腺重量明显增加,术后并发症的发病率[钬激光前列腺剜除术组:5/172(2.9％);传统经尿道前列腺电切术组:19/177(10.7％),P＜0.01]显著下降.3个月后,两组术后PVR、IPSS、QOL以及Qmax较术前相比明显改善(P＜0.01),组间比较差异无统计学意义(P＞0.05).结论 钬激光前列腺剜除术与传统经尿道前列腺电切术相比疗效相当,但安全性更高.钬激光前列腺剜除术治疗临床前列腺增生症具有重要意义.     

良性前列腺增生经尿道钬激光前列腺剜除术的围术期整体护理

目的探讨良性前列腺增生(BPH)经尿道钬激光前列腺剜除术的围术期整体护理方法。方法选取2017-10—2019-04间接受经尿道钬激光前列腺剜除术治疗的40例BPH患者,实施术前针对性心理护理、完善各项手术准备,术后严密观察病情变化、做好管道护理和防治各种并发症,以及加强出院时的健康宣教等整体护理措施。结果40例患者手术过程顺利。术中出血量(89.23±10.30)mL,手术时间(69.31±8.30)min,术后膀胱冲洗时间(11.27±1.82)h。术后出现2例短暂性尿失禁,经对症处理后痊愈。未发生膀胱穿孔、电切综合征和尿道狭窄等其他并发症。拔除尿管后均能自行排尿,排尿障碍明显改善。住院时间(9.58±1.42)d。患者术后均获6个月随访,其间无1例复发。结论对接受经尿道钬激光前列腺剜除术的BPH患者,围术期加强心理、管道、并发症的观察和预防,以及健康教育等整体护理,可提高手术成功率,降低术后并发症发生率,促进患者早期康复。     

钬激光前列腺切除术120例的并发症分析

20 0 1年 8月以来 ,我院使用从美国引进的大功率钬激光器 ,进行钬激光前列腺切除术 (HoLEP)治疗前列腺增生症患者 1 2 0例。本文对术中术后并发症进行了分析。现报告如下。1　临床资料本组 1 2 0例 ,年龄 5 9～ 88岁。病史 3～ 30年。全部手术一次成功。术中大出血 3例 ,出血量 30 0～ 60 0ml;术后出血 3例 ,吸出血凝块约 5 0～ 1 0 0 g ,术后 2 0d继发出血 1例。前尿道狭窄 4例 ,尿道球膜部狭窄 2例 ,尿道黏膜撕脱 1例 ,膀胱损伤 8例 ,尿外渗 3例 ,前列腺包膜穿孔 2例 ,感染 4例。术中前列腺切开后前列腺组织溢出脓液 2例。激光能量 80～…     

经尿道前列腺钬激光剜除术与前列腺电切术治疗良性前列腺增生效果比较

目的比较经尿道前列腺钬激光剜除术与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的效果。方法随机将58例BPH患者分为2组,各29例。对照组行TURP,观察组行经尿道前列腺钬激光剜除术。结果观察组手术时间、术中出血量及术后留置尿管时间、住院时间均少于或短于对照组,差异有统计学意义(P0.05)。2组术后3个月IPSS评分均较术前显著改善,差异有统计学意义(P0.05),但组间无显著性差异(P0.05)。结论经尿道前列腺钬激光剜除术与TURP均能有效改善BPH患者的临床症状,但前者术中出血量少,尿管留置时间短,更利于促进患者早期恢复。     

经尿道前列腺剜除联合耻骨上经膀胱前列腺粉碎治疗巨大前列腺增生

目的 探讨经尿道前列腺完全性剜除联合耻骨上经膀胱前列腺粉碎术治疗巨大前列腺增生的临床应用价值.方法 切除前列腺腺体超过100 g的前列腺增生患者12例,年龄62～78岁,平均（68±3）岁,术前经直肠超声（TRUS）等计算前列腺体积162～263ml,平均（183±21）ml,均采用经尿道前列腺完全性剜除联合耻骨上经膀胱前列腺粉碎术.分析手术的疗效及安全性.结果 12例患者均手术成功,手术时间95～126min,平均（103±11）min,其中完全性剜除前列腺耗时45～78min,平均（65±13）min,腺体粉碎并取出耗时15～35min,平均（22±5）min;切除腺体105～168 g,平均（124±16）g;术后当天血红蛋白下降15～36 g,平均（23±5）g.均未输血;未发生电切综合征、下肢深静脉血栓等并发症.拔除尿管后均排尿通畅,6例发生压力性尿失禁,均在2周内恢复;11例术后住院9d,1例因尿管引流不畅,膀胱造瘘口漏尿,术后住院13d.结论 经尿道前列腺完全性剜除联合耻骨上经膀胱前列腺粉碎术治疗巨大前列腺增生的方法安全可行,可缩短手术时间.     

Progress report on extended clinical use of the argon laser for cutaneous lesions

Since 1970 a variety of cutaneous lesions have been successfully treated with the argon laser and the histopathology carefully studied at the Palo Alto Medical Clinic. Patients with port wine hemangiomas, capillary/cavernous hemangiomas, and telangiectasia have achieved successful resolution in some cases, and subtotal blanching in other cases, with a low incidence of scarring or other complications. Recently, decorative tattoos as well as a variety of miscellaneous pigmented or vascular skin lesions, such as seborrheic keratoses, pyogenic granulomas, and senile angiomas, have also been successfully treated with the argon laser. Total clinical experience is updated in this report.     

Gas volume quantitation during argon ion laser ablation of atheromatous aorta in blood and 0.9% saline media with an optically shielded catheter

Using an optically shielded fiber optic laser catheter, the amount of gas produced when firing an argon ion laser into 0.9% saline solution or blood alone and into atheromatous aorta in either a blood or 0.9% saline medium was quantitated. Energies from 0.25 to 4 joules (J) were used at powers of 2, 5, and 8 W. We found that total volume of gas produced is small not only at equilibrium (0.3 +/- 0.1 microliter/J when firing in blood alone and also when ablating aorta in blood or saline media) but also at peak (2.5 +/- 0.2 microliters/J firing in blood alone and 1.0 +/- 0.1 microliter/J or 0.9 +/- 0.1 microliter/J when ablating aorta in saline or blood, respectively). Because these volumes are small, a clinically significant event from a gas embolus is unlikely during intravascular laser ablation of atheromatous plaque in the energy and power range studied. No gas was quantitated when firing the argon ion laser into 0.9% saline solution alone. The peak gas volume when firing in blood alone was significantly greater than that produced in the other chamber environments. This is thought to be due to increased absorption of argon laser light by hemoglobin. The gas volumes produced by lasing aorta in 0.9% saline or blood were not statistically different.     

Reflectance during pulsed holmium laser irradiation of tissue

Although generally ignored in considerations of laser ablation of tissue, reflectance of laser light from tissue during laser-induced ablation is a potentially important factor in determining ablation efficiency because it determines the amount of laser light coupled into the target. To determine the significance of reflectance changes induced by laser irradiation, we examined the reflectance of liver samples during pulsed holmium laser ablation by placing the target at one focus of an ellipsoidal reflector and a detector at the other focus. The temporal behavior, total reflectance, and effect of multiple pulses were examined. Tissue reflectance as large as 50% was observed during holmium laser irradiation but depended upon laser radiant exposure and number of laser pulses. These measurements suggest that changes in the optical properties of the target during ablation are important and should be considered in detailed modeling of the ablation process.     

Tissue interactions and measurement of ablation rates with ultraviolet and visible lasers in canine and human arteries

Ablation rates measured as the depth of tissue excavation per unit time were determined in human and canine aortas subjected to radiation with ultraviolet (UV) excimer (ArF 193 nm, KrF 248 nm, XeF 351 nm) and visible lasers [continuous wave (cw) and 50-ms chopped argon ion, 478 nm-514 nm; pulsed double-frequency Nd:YAG, 532 nm]. For UV and pulsed double-frequency Nd:YAG lasers ablation rates were constant in time and depended linearly on average laser power, but for cw and chopped argon lasers ablation rates varied with irradiation time and were nonlinearly dependent on laser power. In human aortas, atherosclerosis without gross calcification had no influence on ablation rates. Charring and tissue disruption were observed with cw and chopped argon ion, whereas excimer and pulsed Nd:YAG lasers produced only minimal injury to surrounding tissue. We conclude that the determination of ablation rates is useful for the selection of laser wavelengths and power densities applicable to angioplasty and that UV and pulsed visible laser permit a better control of ablation compared to continuous wave lasers.     

Dependence of the XeCl laser cut rate of plaque on the degree of calcification, laser fluence, and optical pulse duration

A XeCl laser with an optical pulse duration of 35 ns was used to determine the cut depth per laser pulse of postmortem human aorta as a function of laser fluence for four main categories of plaque development. The data indicate that the cut depth per pulse progressively decreases as the degree of calcification increases even at very high (100 mJ/mm2) laser fluences. A comparison was made between the XeCl laser cut rate data obtained using the 35-ns duration laser pulses to data obtained using 200-ns duration pulses for each of the four plaque types. As the degree of tissue calcification increased higher XeCl laser fluences were required for the long pulse case to achieve the same cut depth per pulse as that observed using the shorter pulse duration.     

China report. II. Laser medicine in the People's Republic of China

The application of lasers to medicine in the People's Republic of China allready has an history of more than fifteen years. Lasers are being used in various clinical departments such as ophthalomology, dermatology, otorhinolaryngology, surgery, obstetrics, gynecology, neurology, psychiatry, internal medicine, and acupuncture. A brief account of basic research and instrumentation is also presented. The academic activities of laser medicine in China are increasing repidly, and sugestions for the establishment of a Chinese Laser Medical Society have been proposed. The prospectives for laser medicine appear brilliant and promising.     

Present status of laser neurosurgery

A three-fold approach to the status of laser neurosurgery was taken: 1) Questionnaire to Program Directors for neurosurgery training in the United States and Canada; 2) an analysis of titles in the preliminary neurosurgery program of the Fifth International Congress of Neurosurgery; 3) A literature survey covering the last 3 years of publication. The results showed increasing interest in the use of lasers in neurosurgery, especially for neoplasms in brain and spinal canal. The CO2 laser still dominates the field but Neodymium YAG is also finding wide use. The author comments on directions that laser neurosurgery may take in the future. Special emphasis is made on new applications combining advanced technologies, including CAT scanning, ultrasonography, stereotaxic techniques, and computer control.     

Investigation of carcinogenic effects of in Vitro Argon and CO2 laser exposure of fibroblasts

Mouse heteroploid fibroblasts were grown nine future generations in vitro tissue culture. The cells were exposed to argon laser, CO₂ laser, and x-ray. Results of scoring for mangnant transformation foci were tabulated and compared. Lasers did not produce a significant malignant transformation. Clinical laser use is reviewed and histology as well as long-term clinical experience confirms the safety of lasers.     

Laser applications to arteriosclerosis: Angioplasty,angioscopy, and open endarterectomy

We have studied laser radiation of arteriosclerotic cardiovascular disease to determine the best technique for evaluation. Rabbits with arteriosclerosis were treated by intraluminal laser angioplasty (N = 8), laser angioscopy (N = 2), and open laser endarterectomy (N = 5). All studies were performed with an argon ion laser delivering energy through a 400-μm quartz fiber. Power delivered was varied in order to determine the best value for this animal model. Following angioplasty, perforation was seen in three rabbits (in one case, it was due to mechanical trauma from the fiber optic), and early thrombosis occurred in two rabbits. Plaques were vaporized by angioscopy, but the depth of laser beam penetration or angle of incidence could not be controlled. Open laser endarterectomy gave consistently good results with removal of an arteriosclerotic plaque within the media. The optimum power was found to be 1.0-2.0 W. Endarterectomy required an energy density of 100-140 J/cm². We conclude that open laser endarterectomy can be a standardized technique for the in vivo evaluation of laser radiation upon arteriosclerotic lesions.     

Preliminary results of argon and carbon dioxide laser treatment of keloid scars

Argon and CO2 lasers have been used to treat 13 patients with well-established keloid scars of the trunk or earlobe. Multiple-bore-hole argon technique and total excision with the CO2 laser were attempted. One patient with an earlobe keloid responded to treatment, all other patients had no improvement.