Orihuela E, Motamedi M, Pow-Sang M, LaHaye M, Cowan D F, Warren M M
Department of Surgery, University of Texas Medical Branch, Galveston, USA.
J Urol. 1995 May;153(5):1531-6.
We have previously shown in a canine prostate model that a noncontact low power neodymium:YAG laser regimen of 15 watts for 180 seconds yields a larger volume of coagulation necrosis than the currently recommended high power regimen of 50 watts for 60 seconds. These 2 regimens have not yet been compared in humans. The objective of this study was to evaluate histopathologically the thermocoagulation effect of these 2 laser regimens in the human prostate and the effect of the spatial distribution of the laser lesions on the extent of coagulation necrosis. The study was conducted in 10 patients undergoing radical prostatectomy or cystoprostatectomy. The laser treatment was given transurethrally 1 hour before removal of the specimen. There were no fractures of the prostate. The coagulation necrosis did not reach the peripheral zone and it was minimal in areas rich in fibromuscular tissue, such as the bladder neck. At times, nodular benign prostatic hyperplasia was unaffected. A 4-quadrant treatment in the same plane often yielded small nonconfluent lesions. Confluent lesions in the same plane yielded approximately 30% greater depth of coagulation necrosis, which was achieved when 3 or 4 lesions were created on each side of the prostate (per single transverse plane). Likewise, coagulation necrosis observed with 15 watts for 180 seconds was approximately 40% greater than that noted with the 50 watts for 60 seconds regimen. Our findings suggest that noncontact laser prostatectomy is a safe procedure that can be improved by modifying the laser regimen and the spatial distribution of lesions.
我们之前在犬前列腺模型中已经表明，15瓦持续180秒的非接触式低功率钕：钇铝石榴石激光治疗方案所产生的凝固性坏死体积比目前推荐的50瓦持续60秒的高功率治疗方案更大。这两种治疗方案尚未在人体中进行比较。本研究的目的是通过组织病理学评估这两种激光治疗方案在人前列腺中的热凝效果，以及激光损伤的空间分布对凝固性坏死范围的影响。该研究在10例接受根治性前列腺切除术或膀胱前列腺切除术的患者中进行。在切除标本前1小时经尿道给予激光治疗。前列腺无破裂。凝固性坏死未累及外周带，在富含纤维肌肉组织的区域（如膀胱颈）最小。有时，结节状良性前列腺增生未受影响。在同一平面进行四象限治疗通常会产生小的不融合病变。同一平面的融合病变产生的凝固性坏死深度大约增加30%，当在前列腺每一侧（每个单一横切面）创建3个或4个病变时可实现这一点。同样，15瓦持续180秒观察到的凝固性坏死比50瓦持续60秒治疗方案所观察到的大约大40%。我们的研究结果表明，非接触式激光前列腺切除术是一种安全的手术方法，可通过修改激光治疗方案和病变的空间分布来加以改进。
