选择性绿激光治疗良性前列腺增生症患者(1)
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[摘要] 目的 探讨应用选择性绿激光汽化术(PVP)治疗良性前列腺增生症(BPH)患者的临床疗效。 方法 应用PVP治疗56例BPH患者，观察其治疗效果。 结果 56例手术均成功，术中、术后均无输血，平均手术时间为(60.4±6.6)min。平均留置尿管时间为(3.2±1.5)d，术后3个月国际前列腺症状评分(IPSS)评分、最大尿流率(Qmax)及前列腺体积改变均有统计学意义(P < 0.05)。 结论 PVP治疗BPH手术是一种安全可靠、出血少、并发症少、疗效确切的方法。
[关键词] 绿激光；良性前列腺增生症
[中图分类号] R697+.3 [文献标识码] C [文章编号] 1673-7210(2012)04(a)-0188-02
Green light photo selective vaporization of the prostate for the treatment of benign prostatic hyperplasia
WANG Jin′en MA Chunqing ZHU Cunhai
Department of Urology, Xiaogan Central Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, Xiaogan 432100, China
[Abstract] Objective To evaluate the efficacy of greenlight photoselective vaporization of the prostate (PVP) for the treatment of benign prostatic hyperplasia. Methods Application of PVP treatment of 56 patients with BPH, the treatment effect were observed. Results The PVP was successfully performed on all the 56 patients, none of them received blood transfusion and TUR syndrome. The operative time was (60.4±6.6) min and the postoperative urinary catheter time was (3.2±1.5) d. A significant improvement was observed in Qmax, IPSS values and prostate volume at 3 month (P < 0.01). Conclusion The PVP is safe and efficacious for BPH patients ,with advantages of less blood loss, better tolerance and few complications.
[Key words] Green light; Benign prostatic hyperplasia
前列腺增生症(benign prostate hyperplasia，BPH)是困扰老年男性的常见病，目前外科主要是以经尿道前列腺电切术(TURP)为外科的治疗方法。经尿道选择性绿激光前列腺汽化术(photoselective vaporization of the prostate，PVP)是近年来治疗BPH患者一种新微创手术方式。为评估其疗效，本研究应用PVP治疗BPH患者56例，现报道如下：
1 资料与方法
1.1 一般资料
选取我院2008年3月～2009年3月的56例应用PVP治疗良性前列腺增生患者。年龄56～82岁，平均63.8岁。经直肠超声测定前列腺重35～170 g，平均体积(164.3±13.7)mL；残余尿(residual urine volume，RUV)30～522 mL，平均(172.4±23.8)mL；术前国际前列腺症状评分(international prostate symptom score，IPSS)为21～34分，平均(27.2±3.9)分；术前最大尿流率(Qmax)平均(6.1±2.3)mL/s，所有患者术前抽血检查前列腺特异性抗原(prostate specific antigen，PSA)，其中3例患者PSA值>10 μg/L，术前影像学检查及前列腺穿刺活检排除前列腺癌可能。
1.2 手术方法
硬膜外麻醉后，取截石位，术区常规消毒铺单。我院应用美国Laserscope公式出产的非接触式绿激光治疗仪，激光功率70 W，电凝功率20 W。采用ACMI双鞘汽化镜(23F、30°)，0.9%生理盐水为冲洗液。直视下进行操作，依次观察尿道、前列腺增生、膀胱颈部、膀胱各壁和双侧输尿管开口位置。观察前列腺增生形态及确定精阜位置，同时确定精阜到膀胱颈部的距离。光纤头发出红色光为指示光。以红色瞄准光点进行定位操作，将光纤头以膀胱颈部中叶开始汽化 ......
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