绿激光汽化联合电切治疗前列腺增生症的选择(附520例报告)

目的探讨经尿道选择性绿激光前列腺汽化术(photoselective vaporization of prostate,PVP)和PVP联合经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)两种手术方式的选择。方法应用PVP或PVP联合TURP治疗520例BPH。前列腺重量≥70g年龄85岁186例行PVP联合TURP;≥70g年龄≥85岁72例行PVP;70g者中,215例两侧叶增生为主者行PVP,47例中叶球形增生突入膀胱较多者先PVP汽化腺体5、7点及两侧叶,后TURP辅助彻底切除大部分腺窝内增生腺体。结果本组520例手术时间15~180min,(49.2±33.3)min。术后68例未行膀胱冲洗,452例膀胱冲洗12~48h。住院时间4~9d,(5.6±1.8)d。术后3个月随访431例,国际前列腺症状评分(IPSS)从术前(25.1±6.3)降至(5.5±2.6),最大尿流率(Qmax)从术前(3.9±2.7)ml/s增至(18.1±9.1)ml/s。结论 PVP治疗BPH手术过程安全,出血少,尤其适合于高龄高危患者,对于大容量腺体应用PVP联合TURP效果满意。

Selection of PVP and TURP for Benign Prostatic Hyperplasia: Report of 520 Cases

Objective To study the selection strategy of photoselective vaporization of prostate（PVP）and transurethral resection of prostate（TURP）for benign prostatic hyperplasia（BPH）.Methods We treated totally 520 patients with BPH by using PVP or PVP combined with TURP.PVP combined with TURP was performed on 186 patients,who aged 85 years with the prostate ≥ 70 g in weight;in 72 patients who were ≥85 years with the prostate ≥ 70 g,PVP was carried out;and in the other patients with the prostate 70 g,PVP was made on 215 cases who had BPH in the lateral lobes,and PVP followed by TURP was performed on the 47 patients whose BPH involved mainly the middle lobe penetrating into the bladder（PVP was employed for vaporization of the gland at 5 and 7 o＇clock,as well as the lateral lobes,and then TURP was used to thoroughly remove the hyperplastic tissues）.ResultsPVP or PVP combined with TURP was completed in all the 520 cases in 15 to 180 min with a mean of（49.2±33.3）min.After the procedure,bladder washing was applied in 452 of the cases for 12 to 48 hours.The patients＇ mean hospital stay was（5.6±1.8）days（ranged from 4 to 9 days）.Three months after the operation,431 patients received follow-up examination,which showed a significantly decreased IPSS of 5.5±2.6（before the operation：25.1±6.3）and increased Qmax of（18.1±9.1）ml/s（before the operation：（3.9±2.7）ml/s）.Conclusions PVP is safe for patients with BPH,especially elder high-risk patients,with less intraoperative blood loss.For large-capacity prostate gland,PVP combined with TURP is an ideal option.