1470nm半导体激光前列腺汽化剜除术治疗复杂性良性前列腺增生(附80例报告)  

Clinical research of transurethral vapoenucleation with 1470 nm diode laser for complicated benign prostatic hyperplasia(Report of 80 cases)

作　　者：章俊[1] 王曦龙[1] 史朝亮 张跃辉[1] 张燕宾[1] 屠民琦[1] 施国伟[1] 

机构地区：[1]复旦大学附属上海市第五人民医院泌尿外科,中国上海200240

出　　处：《现代泌尿外科杂志》2017年第3期173-175,180,共4页Journal of Modern Urology

基　　金：上海市科委西医引导项目(No.16411972000);上海市医学重点专科(No.ZK2015B04)

摘　　要：目的探讨经尿道1 470nm半导体激光前列腺汽化剜除术(DiLEP)治疗复杂性良性前列腺增生症(BPH)患者的临床疗效及安全性。方法对2016年1—6月在我院收治并实施DiLEP术的80例复杂性良性BPH患者的临床资料进行回顾性分析,观察包括手术时间、膀胱持续冲洗时间、留置导尿时间、住院天数、手术并发症情况、术后2h较术前血红蛋白下降量、血清钠离子下降量、以及术前和术后1、3个月的患者国际前列腺症状评分(IPSS)、生活质量评分(QoL)、最大尿流率(Qmax)和膀胱残余尿量变化(PVR)。结果 80例手术均成功完成,无中转经尿道前列腺电切术(TURP)及开放手术。手术时间25~112min,平均(59.1±22.5)min;膀胱冲洗时间0~24h,平均(10.8±8.9)h;留置导尿时间1~5d,平均(2.9±0.9)d;住院天数4~9d,平均(6.6±1.3)d;平均术后2h较术前血红蛋白下降量(5.7±1.2)g/L;平均血清钠离子下降量(2.9±1.6)mmol/L。术后1、3个月患者IPSS评分和QoL评分均显著低于术前(P<0.05);术后Qmax均高于术前(P<0.05);术后PVR均少于术前(P<0.05)。术后有5例(6.26%)出现暂时性尿失禁,经提肛锻炼及盆底功能康复治疗后控尿恢复正常。术中无明显出血、无直肠和膀胱穿孔病例,术后无输血、无电切综合征(TURS)、无永久性尿失禁、无尿道狭窄等并发症。结论 1 470nm半导体激光具有良好的组织汽化切割和止血效果,具有创伤小、并发症少、安全性高等优点。因此,经尿道1 470nm DiLEP治疗复杂性良性BPH患者是一种安全、有效的方法。Objective To evaluate the efficacy and safety of 1 470 nm diode laser vapoenucleation of the prostate （DiLEP） for the treatment of complicated benign prostatic hyperplasia （BPH）. Methods The clinical data of 80 cases with complicated BPH treated with DiLEP during Jan. and Jun. 2016 were analyzed retrospectively. These data including the operative time, bladder continuous irrigation time, retaining catheterization time, hospital stay, and perioperative complications were collected. Besides, decrease in hemoglobin and serum sodium levels between 2 h after operation and before operation, international prostate symptom score （IPSS）, quality of life （QoL）, maximum urinary flow rate （Qmax）, and post void residual volume （PVR） before operation and 1 month and 3 months after operation were analyzed. Results All procedures were successful, and none converted to TURP or open surgery. The mean operative time, bladder continuous irrigation time, retaining catheterization time and hospital stay was （59.1±22.5） min, （10.8±8.9） h, （2.9±0.9） d, and （6.6± 1.3） d respectively, while the decrease in mean hemoglobin and serum sodium level was（5.7 ± 1.2）g/L and（2.9 ±1.6）mmol/L accordingly. Compared with preoperative data, IPSS, QoL and PVR were significantly decreased 1 month and 3 months after operation, while Qmax significantly increased （P〈0.05）. Transient urinary incontinence was observed in 5 patients （6.26 %）, and the symptoms were relieved after rehabilitation therapy. Within the 3-month follow-up, no massive hemorrhage, rectal injury, bladder perforation, permanent incontinence, urethral stricture, or TUR syndrome was observed, and no patient received blood transfusion. Conclusion The present study shows that 1 470 nm diode laser vapoenucleation has the advantages of high vaporizing and hemostatic efficiency, with little trauma and few complications. This procedure can be applied for the treatment of compli- cated BPH in a safe and effective manner.

关 键 词：1 470nm半导体激光 前列腺剜除术 前列腺增生 

分 类 号：R697.3[医药卫生—泌尿科学]