高功率双波长龙激光汽化术治疗良性前列腺增生  

High power dual ceralas laser vaporization for benign prostatic hyperplasia

作　　者：吴忠[1] 高鹏[1] 王路加 茅善华[1] 张元芳[1] 沈周俊[1] 丁强[1] 

机构地区：[1]复旦大学附属华山医院泌尿外科,上海200040

出　　处：《临床泌尿外科杂志》2017年第4期255-259,共5页Journal of Clinical Urology

摘　　要：目的:探讨高功率双波长(980nm/1 470nm)龙激光汽化术治疗BPH的疗效及其安全性。方法:2015年8月~2016年8月应用高功率双波长(980nm/1 470nm)龙激光汽化术对我院收治的的58例BPH患者进行了治疗。应用直射光纤接触式汽化及"扫雪技术",将前列腺部尿道汽化消融成类似于TURP术后的宽敞腔道。分别对患者术前、术后3个月及6个月的前列腺体积(经直肠超声)、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、剩余尿量(PVR)和生活质量评分(QOL)等进行前瞻性分析研究,并评估该技术的并发症发生情况。结果:术后3个月随访显示,前列腺体积明显缩小[术前(45.6±27.7)ml vs.术后(28.6±12.2)ml,P=0.000],IPSS明显降低术前[(23.7±5.6)vs.术后(8.1±3.8),P=0.000],Qmax显著增加[术前(8.2±3.1)ml/s vs术后(20.0±2.3)ml/s,P=0.000)],PVR明显减少[术前(170.2±115.5)ml vs.术后(33.6±26.9)ml,P=0.000)],QOL明显改善[术前(4.7±1.1)vs.术后(2.2±0.9),P=0.000]。术后6个月,此5项主、客观参数都有进一步改善。术中、术后无输血,也无其他严重并发症发生。术后最常见并发症为尿路刺激症状:本组为15例(25.9%),多于术后2周消失。3例急迫性尿失禁,于术后2周~1个月左右恢复。结论:我们首次报道高功率双波长(980nm/1470nm)龙激光汽化术治疗BPH,可明显改善IPSS、Qmax、PVR和QOL,且并发症轻微。该技术为BPH的激光治疗带来了新方法,值得进一步研究。Objective： To evaluate the efficiency and safety of vaporization of the high power dual ceralas （980 nm/1 470 nm） laser for treatment of BPH. Method： A total of 58 patients with BPH were included in the study. Preoperative prostate volume （through TRUS）, international prostate symptom score （IPSS）, maximal flow rate （Qmax）, post-voided residual urine （PVR） and quality of life （QOL） were compared at three and six months postoperatively. Complications were also assessed. Contact vaporization with ＂sweeping snow＂ technique was used to give a TURPqike cavity. Postoperative irrigation was not used routinely. Result： Postoperative three-month follow-up revealed that prostate volume decreased from （45.6±27.7） ml to （28.6± 12.2） ml, P =0. 000, and IPSS decreased from （23.7± 5.6） to （8.1±3.8）, P= 0. 000. The mean Qmax increased significantly from （8.2±3.1） ml/s to （20.0±2.3） ml/s, P=0. 000. PVR decreased significantly from （170.2±115.5） ml to （33.6±26.9） ml, P=0. 000. QOL changed considerably compared to baseline, All of these values showed slight improvement at six-month follow-up. No blood transfusion or other severe complications were encountered during and after the procedures. The most common postoperative complications were irritative symptoms （15 of 58, or 25.9%） which subsided at two weeks. Three patients had temporary combined urge and stress incontinence for two weeks to one month. Conclusion： The high power dual ceralas （980 nm/1 470 nm） laser vaporization provided significant improvements in IPSS, Qmax, PVR and QOL with low morbidity. These results of prostatic vaporization with the high power dual ceralas （980 nm/1 470 nm） laser, representing what is to our knowledge the first clinical study in the literature, are encouraging and needs to be further elucidated.

关 键 词：良性前列腺增生 双波长激光 激光 汽化术 

分 类 号：R697.3[医药卫生—泌尿科学]