摘要目的 探讨经尿道160 W经尿道选择性绿激光前列腺汽化术(PVP)治疗伴发多种内科基础疾病的高危BPH患者的安全性及临床疗效。方法 选取2013年9月~2016年3月收治的180 例高危BPH患者,随机分为3组(160 W PVP组、80 W PVP组、TURP组),每组60例。手术前后检测血红蛋白、血钠水平;术后随访6个月,检测术前及术后Qmax、PVR,并行IPSS、QOL评分,记录术后不良反应、留置尿管时间、住院时间及近期并发症的发生情况。结果 手术均顺利完成,随访6个月,无失访者。三组患者的平均年龄和前列腺平均体积差异无统计学意义(均P>0.05)。三组患者术前、术后的IPSS、Qmax、PVR、QOL观察指标比较均差异有统计学意义(均P<0.05)。三组的手术前后血红蛋白的变化、平均手术时间比较均差异有统计学意义(均P<0.05)。160 W PVP组和80 W PVP组的术中血清钠的变化、术后留置尿管时间、住院时间的比较差异无统计学意义(P>0.05),但与TURP组比较均差异有统计学意义(P<0.05)。所有患者均未输血,无前列腺包膜穿孔,无电切综合征发生。术后无尿失禁、继发性出血。随访期内疗效满意。结论 三种方式相比都能有效地减轻BPH患者的下尿路症状、改善生活质量,疗效相当。同时PVP相对于TURP具有出血少、安全性高的优点,尤其新一代高功率160 W PVP治疗BPH,术中出血更少、效率更高、手术更快,尤其适合合并内科疾病、耐受力较差的高危BPH患者。
Abstract：Objective: To investigate the safety and clinical efficacy of transurethral 160 W green laser prostate hyperthermia in the treatment of high risk benign prostatic hyperplasia (BPH) by comparing the curative effectiveness of 160 W PVP or 80 W PVP with TURP in the treatment of high risk BPH. Methods: A total of 180 elderly patients with BPH who had one or more important organ comorbidities were treated in our hospital from September 2013 to March 2016 were selected, and randomly assigned into 3 groups, 60 patients in each group: 160 W transurethral vaporization of the prostate (PVP) group (given 160 W green laser system by transurethral vaporization of the prostate), 80 W PVP group (given 80 W green laser system using transurethral vaporization of the prostate), and TURP group (given transurethral resection of the prostate). Hemoglobin and serum sodium were measured before and after surgery. The patients were followed up for 6 months. The Qmax, PVR, IPSS and QOLwere measured before and 6 months after operation. The postoperative adverse reactions, indwelling catheterization time, hospitalization time and the occurrence of recent complications were recorded. Results: The surgical operations were successfully performed, and no patients lost follow-up. The mean age and the mean volume of the prostate showed no statistically significant difference amond three groups (P>0.05). Before and after surgery, IPSS, Qmax, PVR and QOL showed statistically significant differences among three groups (P<0.05). There was significant difference in the changes of hemoglobin before and after operation and the average operation time among three groups (P<0.05). There was no significant difference in the changes of serum sodium before and after operation, and postoperative catheterization time and hospitalization time between 160 W PVP group and 80 W PVP group (P>0.05), but there was significant difference between 160 W PVP group or 80 W PVP group and TURP group (P<0.05). All patients had no blood transfusion, no electrical resection syndrome and no prostate perforation. There was no postoperative incontinence and secondary bleeding. During the follow-up period, the efficacy was satisfactory. Conclusions: 160 W PVP and 80 W PVP can more effectively improve the quality of life and reduce the lower urinary tract symptoms of BPH patients than TURP. At the same time, PVP has the advantages of less bleeding, with high security, especially the new generation of high power 160 W PVP for the treatment of BPH, with fewer bleeding, higher efficiency, faster operation, especially suitable for high risk BPH patients complicated with medical diseases and having poor tolerance.
沈善林, 于江, 刘佃成. 不同功率绿激光与经尿道前列腺切除术治疗高危良性前列腺增生症的对比研究[J]. 微创泌尿外科杂志, 2018, 7(6): 418-422.
Shen Shanlin, Yu Jiang, Liu Diancheng. A comparative study of different power green laser and transurethral prostatectomy in the treatment of high risk benign prostatic hyperplasia. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(6): 418-422.
[1] 杨国胜,刘刚.绿激光治疗前列腺增生的优势及进展.中华腔镜泌尿外科杂志(电子版),2016,10(1):1-4. [2] 余克勤,李海博,单玉喜,等.选择性绿激光汽化术治疗高危复发性良性前列腺增生.中华男科学杂志,2015,21(6):573-575. [3] 曲华伟,刘辉,刘京生,等.160W直束绿激光剥离汽化术治疗良性前列腺增生症.泌尿外科杂志(电子版),2015,7(3):43-46. [4] Tritschler S, Roosen A, Füllhase C, et al.Urethral stricture: etiology, investigation and treatments. Dtsch Arztebl Int, 2013,110(13):220-226. [5] Giulianelli R, Gentile B, Albanesi L, et al.Bipolar button transurethral enucleation of prostate in benign prostate hypertrophy treatment: a new surgical technique. Urology, 2015,86(2):407-413. [6] Chen CH, Lin SE, Chiang PH.Outcome of GreenLight HPS laser therapy in surgically high-risk patients. Lasers Med Sci, 2013,28(5):1297-1303. [7] Rieken M, Bachmann A.Laser treatment of benign prostate enlargement-which laser for which prostate? Nat Rev Urol, 2014,11(3):142-152. [8] 沈善林,徐忠华,刘殿成,等.经尿道高功率绿激光前列腺汽化术治疗高危良性前列腺增生症效果观察.山东医药,2017,57(6):90-92. [9] Meskawi M, Hueber PA, Valdivieso R, et al.Multicenter international experience of 532 nm laser photovaporization with Greenlight XPS in men with large prostates (prostate volume >100cc). World J Urol, 2017,35(10):1603-1609. [10] Kim JW, Kim YJ, Lee YH, et al.An analytical comparison of short-term effectiveness and safety between Thulium:YAG laser vaporesection of the prostate and bipolar transurethral resection of the prostate in patients with benign prostatic hyperplasia. Korean J Urol, 2014,55(1):41-46. [11] Batura D, Sahibzada I, Elkabir J, et al.Durability and complications of photoselective vaporisation of the prostate with the 120W high performance system GreenLightTM Lithium triborate laser. Ann R Coll Surg Engl, 2014,96(5):359-363. [12] Han HH, Ko WJ, Yoo TK, et al.Factors associated with continuing medical therapy after transurethral resection of prostate. Urology, 2014,84(3):675-680. [13] Jones P, Alzweri L, Rai BP, et al.Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis. Arab Journal of Urology, 2016,14(1):50-58. [14] Tao W, Xue B, Zang Y, et al.The application of 120-W high-performance system GreenLight laser vaporization of the prostate in high-risk patients. Lasers Med Sci, 2013,28(4):1151-1157. [15] Ben-Zvi T, Hueber PA, Liberman D, et al.GreenLight XPS 180W vs HPS 120W laser therapy for benign prostate hyperplasia: a prospective comparative analysis after 200 cases in a single-center study. Urology, 2013,81(4):853-858. [16] 符伟军,宋勇,王威,等.经尿道等离子前列腺分叶剜除术治疗良性前列腺增生的规范化手术步骤及初步临床应用.微创泌尿外科杂志,2017,6(5):305-308. [17] Grande M, Facchini F, Moretti M, et al.History of laser in BPH therapy. Urologia, 2014,81(Suppl 23):S38-S42. [18] 蔡星建,张慕淳,张茁,等.1470nm激光前列腺剜除术治疗良性前列腺增生(附28例报告).微创泌尿外科杂志,2016,5(5):275-277.
