经尿道 2 微米连续波激光分割汽化切除术治疗大体积良性前列腺增生。

Transurethral dividing vaporesection for the treatment of large volume benign prostatic hyperplasia using 2 micron continuous wave laser.

机构信息

Department of Urology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.

出版信息

Chin Med J (Engl). 2010 Sep;123(17):2370-4.

Abstract

BACKGROUND

The safety and efficiency of transurethral laser resection of the prostate to treat benign prostatic hyperplasia have been verified. However, this method does still not manage large volume prostates efficiently. To tackle this problem, we have designed a method of "transurethral dividing vaporesection of prostate" using a 2 micron continuous wave laser. The aim of this study was to evaluate the safety and efficiency of this method in the management of large prostates (> 80 ml).

METHODS

In this study, 45 cases of benign prostatic hyperplasia with a median prostatic volume of (123.7 ± 26.7) ml (range, 80.2-159.8 ml) were treated by the same surgeon under epidural anesthesia. During the surgery, superapubic catheters were needed, and saline solution was used for irrigation. First, the prostate was divided longitudinally into several parts from the bladder neck to the prostatic apex, and then gradually incised transversely chip by chip. Intraoperative blood transfusion rate, postoperative complications, maximum urinary flow rate, International Prostate Symptom Score and quality of life scores were recorded for statistical analysis using SPSS 16.0 software.

RESULTS

Intraoperatively, no transurethral resection syndrome was observed, and no blood transfusions were needed. The resected prostatic chips were easily flushed out of the bladder through the resectoscope sheath without the use of a morcellator. Median vaporesection time was (95.0 ± 13.2) minutes (range, 75-120 minutes), and the median retrieved and removed prostatic tissue were (25.2 ± 5.1) g (range, 15.5-34.7 g) and (75.4 ± 16.4) g (range, 43.8-106.1 g), respectively. Median catheter time and hospital stay were (3.3 ± 0.9) days (range, 3-5 days) and (4.8 ± 1.8) days (range, 3-9 days), respectively. After a follow-up of 6 to 12 months, two patients had stress urinary incontinence and three had anterior urethral strictures. Satisfactory improvement was seen in maximum urinary flow rate, International Prostate Symptom Score and quality of life scores.

CONCLUSIONS

This study showed that 2 micron laser vaporesection is a safe treatment for benign prostatic hyperplasia patients with large prostates, and the method of "dividing vaporesection" may help improve both surgical efficiency and patient outcomes.

摘要

背景

经尿道前列腺激光切除术治疗良性前列腺增生症的安全性和有效性已得到验证。然而，这种方法对于治疗大体积前列腺仍然效率不高。为了解决这个问题，我们设计了一种使用 2 微米连续波激光的“经尿道前列腺分割汽化切除术”方法。本研究旨在评估该方法在处理大前列腺（>80ml）中的安全性和有效性。

方法

本研究中，45 例良性前列腺增生患者在硬膜外麻醉下由同一位外科医生进行治疗，前列腺体积中位数为（123.7±26.7）ml（范围 80.2-159.8ml）。手术过程中需要耻骨上导管，并用生理盐水冲洗。首先，从膀胱颈到前列腺尖纵向将前列腺分割成几个部分，然后逐渐横向分割成薄片。使用 SPSS 16.0 软件对术中输血率、术后并发症、最大尿流率、国际前列腺症状评分和生活质量评分进行记录和统计分析。

结果

术中未观察到经尿道电切综合征，无需输血。通过电切镜鞘很容易将切除的前列腺组织芯片冲出膀胱，无需使用碎石器。汽化切割中位时间为（95.0±13.2）分钟（范围 75-120 分钟），中位切除和取出的前列腺组织分别为（25.2±5.1）g（范围 15.5-34.7g）和（75.4±16.4）g（范围 43.8-106.1g）。中位导尿管时间和住院时间分别为（3.3±0.9）天（范围 3-5 天）和（4.8±1.8）天（范围 3-9 天）。随访 6-12 个月后，2 例患者发生压力性尿失禁，3 例患者发生前尿道狭窄。最大尿流率、国际前列腺症状评分和生活质量评分均有满意改善。