汽化电切术对前列腺及其周围组织损伤程度的研究

目的 :临床研究表明 ,经尿道前列腺电汽化术 (TVP)可达到与经尿道前列腺电切术 (TURP)相同的治疗效果 ,且并发症少 ,但缺少相应的病理资料支持。本实验以犬为模型 ,评价汽化术后前列腺病理改变。　方法 :9条家犬切开膀胱 ,使用Storz公司电汽化设备行经膀胱逆行电汽化术。分别在 0周 (术后立即 )、1周及 5周后被处死 ,获取前列腺标本 ,行大体及光镜下病理观察电汽化损伤及坏死深度。　结果 :2 70W 0周汽化坏死层小于 1.8mm ,1周后最深不超过 3mm ,伴明显急性炎症充血。 180W 0周及 1周坏死深度分别不超过 1.3mm及 2 .2mm。12 0W电切坏死层最大分别为 1.1mm及 1.6mm。坏死层均局限于前列腺本身 ,周围组织病理未见明显改变。 5周后前列腺标本均示腺上皮已基本再生 ,但仍存在充血炎症反应。　结论 :TVP的犬模型显示在汽化部位层下仅为较浅的局限性坏死。这些病理资料为临床电汽化前列腺效果好且并发症少的结论提供了很好的理论依据。

Effect of Electrovaporization on the Prostate and Its Surrouding Tissues

Objective: Transurethral electrovaporization of the prostate(TVP) for benign prostatic hyperplasia(BPH) has proven to be efficacious with lower morbidity than transurethral resection of the prostate(TURP) on clinical studies. Howerer, no histopathologic data are available to support the clinical findings in human studies. The following study was done using a canine model in an effort to evaluate these histopathologic changes. Methods: Nine canines received antegrade electrovaporization or resection of the prostate, via an open cystomy, using Storz series resectoscope and video equipment. The dogs were sacrified and their prostates harvested at 0 week (immediately after operation),1 week or 5 weeks after electrovaporization or resection. The prostates were evaluated grossly as well as histologically for cavitary defects and depth of necrosis. Results: Prostate examination revealed superficial necrosis (less than 1.8 mm deep) at 0 week following the 270 watts operation, and less than 3 mm deep necrosis with acute inflammation and focal hemorrhage at 1 week. The depths of necrosis were less than 1.3 mm and 2.2 mm at 0 week and 1 week after the 180 W electrovaporizion. And the 120 W resection resulted in necrosis 1.1 mm and 1.6 mm deep at most, which was locaized in the vaporized prostate only, with no histopathologic change in the surrounding tissues. Epithelial stratification was underway by the fifth week, but with inflammation. Conclusion: TVP in the canine model showed only shallow necrosis at the site of the vaporization.These data provide a histopathologic rationale for the minimal morbidity and efficacious nature of this technique demonstrated in clinical studies. Natl J Androl,2004,10(10):747-750