经尿道前列腺电切气化术治疗前列腺增生568例报告

目的 :进一步探讨前列腺增生 (BPH)的有效手术新方法。方法 :采用经尿道前列腺电切术和气化术治疗BPH患者 5 6 8例。结果 :疗效满意 ,术后 3～ 6个月随访 ,国际前列腺症状评分 (IPSS) 8.5± 1.5分 ;最大尿流率 (Q max) 2 0 .5± 4 .5ml s,剩余尿量 2 9.1± 14 .2ml,未出现严重并发症。结论 :将电切和气化相结合行经尿道前列腺切除术是一种安全性高、并发症少、疗效确切的新手术方法 ,具有操作易掌握、出血少、速度快、安全可靠等优点。     

经尿道前列腺电汽化术治疗前列腺增生(附386例报告)

目的探讨经尿道前列腺电汽化术（TVP）治疗前列腺增生的疗效。方法回顾分析采用经尿道前列腺电汽化术治疗386例前列腺增生（BPH）患者的临床资料。结果术中发生前列腺包膜穿孔2例,电切综合征（TURS）1例。术后随访1月-5年,术后3月内出血6例,前列腺尖部黏连狭窄1例,远期出血2例发生在术后1-3年。术后3个月最大尿流率（Qmax）12.3-23.5mL/s,平均18.5mL/s;IPSS评分6-17分,平均9.5分。结论经尿道电汽化术治疗前列腺增生效果明显,腺体残留是术后出血、排尿困难的主要原因。     

经尿道前列腺电汽化联合撬拨术治疗高龄前列腺增生症

目的探索微创手术治疗高龄前列腺增生症(benign prostatic hyperlasia,BPH)的安全有效新方法. 方法采用经尿道前列腺电汽化(transurethal vaporiyation of prostate,TUVP)联合撬拨术治疗80岁以上BPH 68例. 结果手术时间30～160 min,平均60 min,切除腺体重量12.5～98.5 g,平均37.6 g,术中出血量30～120 ml,平均65 ml,术后住院5～7 d,平均6 d.术后随访0.5～2年,国际前列腺症状评分由(23.5±4.2)分降至(6.5±2.1)分,生活质量评分由(4.6±0.6)分降至(2.2±0.2)分,最大尿流率由(8.7±4.3)ml/s升至(18.0±2.2)ml/s,剩余尿由(176.0±86.7)ml降至(12.2±2.4)ml.与术前相比,术后6个月均得到显著改善(P＜0.01). 结论 TUVP加撬拨术治疗高龄BPH安全有效,并发症少.     

膝关节粘连关节镜下射频汽化消融松解术

目的总结关节镜下射频汽化消融技术在膝关节粘连松解术中的应用体会及短期临床效果。方法2002年1月至2005年6月,对各种原因所致膝关节粘连32例行关节镜下射频汽化消融粘连松解术。依据关节造影所示粘连程度分为3组：A组18例髌上囊粘连,单纯做髌上囊及内外侧沟上方成形。B组8例主要为关节间隙粘连,在做髌上囊及侧沟粘连带清理后加髁问窝清理,加压屈曲膝关节,切断内外侧关节间隙粘连带。C组6例膝关节大部分粘连,进镜操作困难者加做髌骨内外上极小切口,先做髌上囊钝性分离造成腔隙,然后镜下进一步松解。松解配合推拿。射频汽化电极点凝行关节腔内彻底止血。术后不留置引流,第2天开始被动结合主动膝关节加压屈伸功能锻炼。结果A组术前屈曲35°～75°,术后3周115°～125°,平均改善78°；B组术前屈曲40°～60°,术后3周95°～120°,平均改善72°；C组术前屈曲25°～45°,术后3周90°～110°,平均改善64°。术后关节腔内无积血,关节及其周围组织肿胀轻。结论关节镜下射频汽化消融松解膝关节粘连出血少,创伤小,松解效果可靠,可避免以往方法的不利因素,对于髌上囊、侧沟或关节间隙粘连的患者尤为适用。     

前列腺增生症伴有神经源性排尿功能障碍的处理

目的：提高对前列腺增生症伴有神经源性排尿功能障碍的认知和处理水平。方法：回顾分析14例前列腺增生症伴有神经源性排尿功能障碍患者的临床资料、尿动力学检查、诊断、处理及预后情况。结果：14例中行前列腺电气化9例,趾骨上经膀胱前列腺摘除术1例,膀胱永久造瘘2例,药物保守治疗2例。电气化患者1例出现永久性尿失禁,1例术后1年又出现增生,经再次气化治疗后痊愈,其余患者排尿均明显改善,残余尿减少或消失。结论：前列腺增生症伴有原性尿功能障碍并不少见,通过细致的检验和尿动力学检查,明确神经性排尿功能障碍的严重程度,选择恰当的治疗方案能够改善排尿症状,减少永久膀胱造瘘,最大限度地提高病人的生活质量。     

经尿道气化结合电切术治疗高危前列腺增生107例报告

目的　探讨高危前列腺增生症 (BPH)患者的有效手术方法。方法　采用经尿道前列腺气化术(TVP)结合电切术 (TURP)治疗高危 BPH患者 10 7例。结果　平均手术时间 5 6 m in,平均失血量 90 ml,均未输血 ,无 TURS发生。 89例术后随访 3个月至 2年 ,国际前列腺症状评分 (IPSS) ,由术前 2 6 .8± 5 .9分术后降至 8.7± 4 .3分 (P<0 .0 0 1)。最大尿流率 (Qmax)由术前 5 .0± 4 .2 ml/ s,术后升至 16 .2± 4 .5 m l/ s (P<0 .0 0 1)。剩余尿量(PUR)由术前 137.6± 5 4 .9ml术后降至 2 1.8± 16 .1ml(P<0 .0 0 1)。结论　TVP结合 TURP安全性高、并发症少、效果确切 ,只要处理方法得当 ,适合高危 BPH患者     

患者组成变化和个人学习曲线对经尿道前列腺电汽化切除术疗效的影响

目的：探讨BPH患者组成变化和个人学习曲线对经尿道前列腺电汽化切除术（TUVRP）疗效的影响。方法：回顾惟分析由一个医生实施的270例TUVRP的临床资料,其中A组为早期100例,B组为最后170例。分析项目包括患者年龄、前列腺体积、BPH并发症、影响排尿功能疾病、手术方式和时间、ASA体格情况分级、手术并发症、IPSS评分、最大尿流率等。结果：与A组相比．B组年龄提高4．35岁（P〈0．001）,前列腺体积增加23．3g（P〈0．001）,伴有的BPH并发症、影响排尿功能疾病、全身性疾病显著增加,无中转开放手术患者;手术时间减少18．54min（P〈0．001）,术前和术后血红蛋白含量显著减少;膀胱冲洗、止血剂应用、围术期输血、手术并发症明显减少,无死亡和二次手术患者。两组术后IPSS评分、QOL指数、最大尿流率、平均尿流率均有明显改善。结论：近年来BPH手术患者出现高龄化趋势,大多出现严重并发症后才接受手术。随着患者数量的积累,术者的操作技能逐步提高,从而获得更好的疗效。TUVRP是一种有效的BPH治疗方法,宜普及推广。     

直出绿激光汽化切除术与选择性绿激光汽化术治疗良性前列腺增生的疗效分析*

目的总结分析直出绿激光前列腺汽化切除术(PVRP)与选择性绿激光前列腺汽化术(PVP)在治疗良性前列腺增生症(BPH)方面的安全性和临床疗效。方法将113例BPH患者随机分为两组,PVRP组62例,PVP组51例。比较两组手术时间、术中出血量、术后持续膀胱冲洗时间、导尿管留置时间;观察两组手术前、后生活质量评分(QOL)、国际前列腺症状评分(IPSS)、残余尿量(PVR)、最大尿流率(Q_(max))及术后并发症发生情况。结果所有患者手术均成功,无严重并发症发生。PVRP手术时间(49.4±18.9)min明显少于PVP组(75.1±20.7)min(P0.05);两组间术中出血量、膀胱冲洗时间比较差异无统计学意义(P0.05)。两组术后6个月Q_(max)、PVR、IPSS、QOL均明显改善,与术前比较差异均有统计学意义(P0.05)。两组间比较,上述指标间差异均无统计学意义(P0.05)。结论直出光PVRP及PVP治疗BPH安全、有效,PVRP在手术时间上较PVP更有优势。     

Characterization of Acoustic Droplet Vaporization for Control of Bubble Generation Under Flow Conditions

This study investigated the manipulation of bubbles generated by acoustic droplet vaporization (ADV) under clinically relevant flow conditions. Optical microscopy and high-frequency ultrasound imaging were used to observe bubbles generated by 2-MHz ultrasound pulses at different time points after the onset of ADV. The dependence of the bubble population on droplet concentration, flow velocity, fluid viscosity and acoustic parameters, including acoustic pressure, pulse duration and pulse repetition frequency, was investigated. The results indicated that post-ADV bubble growth spontaneously driven by air permeation markedly affected the bubble population after insonation. The bubbles can grow to a stable equilibrium diameter as great as twice the original diameter in 0.5–1 s, as predicted by the theoretical calculation. The growth trend is independent of flow velocity, but dependent on fluid viscosity and droplet concentration, which directly influence the rate of gas uptake by bubbles and the rate of gas exchange across the wall of the semipermeable tube containing the bubbles and, hence, the gas content of the host medium. Varying the acoustic pressure does not markedly change the formation of bubbles as long as the ADV thresholds of most droplets are reached. Varying pulse duration and pulse repetition frequency markedly reduces the number of bubbles. Lengthening pulse duration favors the production of large bubbles, but reduces the total number of bubbles. Increasing the PRF interestingly provides superior performance in bubble disruption. These results also suggest that an ADV bubble population cannot be assessed simply on the basis of initial droplet size or enhancement of imaging contrast by the bubbles. Determining the optimal acoustic parameters requires careful consideration of their impact on the bubble population produced for different application scenarios.     

Assessment of personal airborne exposures and surface contamination from x-ray vaporization of beryllium targets at the National Ignition Facility

This article presents air and surface sampling data collected over the first two years since beryllium was introduced as a target material at the National Ignition Facility. Over this time, 101 experiments with beryllium-containing targets were executed. The data provides an assessment of current conditions in the facility and a baseline for future impacts as new, reduced regulatory limits for beryllium are being proposed by both the Occupational Safety and Health Administration and Department of Energy. This study also investigates how beryllium deposits onto exposed surfaces as a result of x-ray vaporization and the effectiveness of simple decontamination measures in reducing the amount of removable beryllium from a surface. Based on 1,961 surface wipe samples collected from entrant components (equipment directly exposed to target debris) and their surrounding work areas during routine reconfiguration activities, only one result was above the beryllium release limit of 0.2 µg/100 cm² and 27 results were above the analytical reporting limit of 0.01 µg/100 cm², for a beryllium detection rate of 1.4%. Surface wipe samples collected from the internal walls of the NIF target chamber, however, showed higher levels of beryllium, with beryllium detected on 73% and 87% of the samples during the first and second target chamber entries (performed annually), respectively, with 23% of the samples above the beryllium release limit during the second target chamber entry. The analysis of a target chamber wall panel exposed during the first 30 beryllium-containing experiments (cumulatively) indicated that 87% of the beryllium contamination remains fixed onto the surface after wet wiping the surface and 92% of the non-fixed contamination was removed by decontaminating the surface using a dry wipe followed by a wet wipe. Personal airborne exposures assessed during access to entrant components and during target chamber entry indicated that airborne beryllium was not present in workers' breathing zones. All the data thus far have shown that beryllium has been effectively managed to prevent exposures to workers during routine and non-routine work.