Childs S J
Department of Surgery, University of Alabama, Tuscaloosa, USA.
J Endourol. 1995 Apr;9(2):163-9. doi: 10.1089/end.1995.9.163.
Initial studies utilizing the original visual laser ablation prostatectomy (VLAP) technique of coagulation and a pilot study applying laser energy to prostate cancer led to the realization that these procedures could be monitored effectively in real time by ultrasound. Physical and chemical changes occur in prostate tissue with heating by laser energy, and these changes can be detected, not only as cavitation when the prostate tissue is vaporized, but also as a hyperechoic alteration that presumably is cell death leading to necrosis. Utilizing real-time monitoring helps assure the efficacy of the procedure and predict greater cavitation from slough of dead tissue. Monitoring by ultrasound scanning also allows following of the change of directions of the laser beam in tissue, which could be dangerous to the patient. With ultrasonography, one can make sure that the neurovascular bundle is not compromised and that the energy is not allowed to proceed past the posterior capsule of the prostate into the rectal wall. This is particularly helpful in patients with a high bladder neck but with minimal prostatic tissue posteriorly at the base. Also, the amount of tissue and the length from the verumontanum to the external sphincter can be accurately assessed and correlated with the lesion created at that level to avoid damage to the external sphincter.
最初利用原始的可视化激光消融前列腺切除术（VLAP）的凝固技术进行的研究以及一项将激光能量应用于前列腺癌的初步研究，使得人们认识到这些手术可以通过超声进行有效的实时监测。随着激光能量加热，前列腺组织会发生物理和化学变化，这些变化不仅可以在前列腺组织汽化时作为空化现象被检测到，还可以作为一种高回声改变被检测到，这种高回声改变推测是导致坏死的细胞死亡。利用实时监测有助于确保手术的疗效，并预测死组织脱落会产生更大的空化现象。通过超声扫描进行监测还可以跟踪激光束在组织中的方向变化，这对患者可能是危险的。借助超声检查，可以确保神经血管束不受损害，并且能量不会越过前列腺的后包膜进入直肠壁。这对膀胱颈高位但前列腺底部后方组织最少的患者特别有帮助。此外，可以准确评估组织量以及从精阜到外括约肌的长度，并将其与该水平处形成的病变相关联，以避免对外括约肌造成损伤。
