Xu Yong, Sun Dong-chong, Yang Yong, Wei Zhi-tao, Hong Bao-fa, Zhang Xu
Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2013 Feb 1;51(2):119-22.
To summarize the 5-year follow-up to 2 micron continuous wave laser vaporesection for the treatment of patients with low urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), and evaluate the safety and clinical effects of the treatment.
From October 2006 to September 2007, 236 cases with low urinary tract symptom secondary to BPH were treated transurethrally under epidural or general anesthesia using the 70 Watt 2 micron laser system. Vaporesection of the prostate was performed with the traditional "U" or the "dividing" method. The 210 cases who met the inclusion criteria in this study were selected for further observation. Baseline and perioperative data were recorded and evaluated in resection time, transfusion rate, catheter-time, improvements in maximal urinary flow rate (Qmax), international prostate symptom scores (IPSS), quality of life (QoL), and post voiding residual volume (PVR).
Out of the 210 cases, 179 cases were followed up to 5 years finally. All the surgical procedures were successfully conducted under epidural or general anesthesia. Mean operation time was (80 ± 22) minutes, and mean retrieved prostatic tissue was (24.9 ± 4.2) g. Resected prostatic tissues could be easily flashed out of the bladder. There were no significant differences in serum sodium concentrations and hemoglobin levels before and after the surgery. Mean catheter time and hospital stay was (114 ± 35) hours and (5.7 ± 1.9) days respectively. Only one postoperative secondary hemorrhage was found and treated with blood transfusion. During the 5-year follow-up, Qmax increased from (8.6 ± 3.5) ml/s preoperatively to (23.6 ± 4.2) ml/s by the end of the follow-up (P < 0.01), IPSS and QoL-Score improved from 25.3 ± 5.2 and 4.1 ± 1.3 to 6.1 ± 3.0 and 1.4 ± 0.8 respectively (P < 0.01), and PVR decreased from (248 ± 89) ml to (15 ± 13) ml. The 3 patients developed urinary incontinence and recovered 3 months later through functional exercises with the help of acupuncture. Five patients were found to have urethral stricture 3 months after the surgery and recovered with the treatment of urethral dilatation (3 cases) or internal urethrotomy (2 cases) respectively.
Transurethral vaporesection of prostate using the 2 micron continuous wave laser system is a safe and effective treatment for benign prostatic hyperplasia with obvious improvements in subjective and objective voiding parameters, which were evident at 3 months after the surgery and were sustained throughout the 5-year long-term follow-up.
总结2微米连续波激光汽化切除术治疗良性前列腺增生（BPH）继发下尿路症状（LUTS）患者的5年随访情况，评估该治疗方法的安全性和临床效果。
2006年10月至2007年9月，236例BPH继发下尿路症状患者在硬膜外或全身麻醉下经尿道使用70瓦2微米激光系统进行治疗。采用传统的“U”形或“分割”法进行前列腺汽化切除术。选取本研究中符合纳入标准的210例患者进行进一步观察。记录并评估基线和围手术期数据，包括切除时间、输血率、导尿管留置时间、最大尿流率（Qmax）、国际前列腺症状评分（IPSS）、生活质量（QoL）及排尿后残余尿量（PVR）的改善情况。
210例患者中，最终179例获得5年随访。所有手术均在硬膜外或全身麻醉下成功完成。平均手术时间为（80±22）分钟，平均切除前列腺组织为（24.9±4.2）克。切除的前列腺组织可轻松从膀胱冲出。手术前后血清钠浓度和血红蛋白水平无显著差异。平均导尿管留置时间和住院时间分别为（114±35）小时和（5.7±1.9）天。仅发现1例术后继发性出血，经输血治疗。在5年随访期间，Qmax从术前的（8.6±3.5）毫升/秒增加到随访结束时的（23.6±4.2）毫升/秒（P<0.01），IPSS和QoL评分分别从25.3±5.2和4.1±1.3改善至6.1±3.0和1.4±0.8（P<0.01），PVR从（248±89）毫升降至（15±13）毫升。3例患者出现尿失禁，3个月后在针灸辅助下通过功能锻炼恢复。5例患者术后3个月发现尿道狭窄，分别经尿道扩张（3例）或内尿道切开术（2例）治疗后恢复。
使用2微米连续波激光系统经尿道前列腺汽化切除术是治疗良性前列腺增生的一种安全有效的方法，主观和客观排尿参数有明显改善，术后3个月即很明显，并在5年的长期随访中持续存在。
