选择性绿激光前列腺汽化术临床应用.docVIP

选择性绿激光前列腺汽化术临床应用 　 作者;石磊，刘洪生，吕秋元，薛建平，李筱军，周熠华 ［摘要］ 目的 探讨经尿道选择性绿激光前列腺汽化术治疗前列腺增生症（BPH）的安全性和疗效。方法 采用硬膜外麻醉，应用PVP治疗35例BPH患者。观察麻醉效果、手术时间、术中术后出血情况、手术前后尿流率、术后留置尿管时间、性功能等情况。结果 除4例为骶麻，其余31例均采用硬膜外麻醉。麻醉效果良好，手术时间19～112 min，术后均留置尿管，术后留置尿管时间24～72 h，其中拔除尿管后出现1例短暂排尿困难，4例拔除尿管后有膀胱刺激症状。无术后发热病例。术中无输血病例，无继发性出血、尿失禁等并发症发生。8例术前保持性功能者术后均保留良好功能。术后回访1个月，最大尿流率由术前平均（6.5±2.6）ml/s增至术后（19.3±2.1）ml/s。结论 PVP治疗BPH，具有出血少、时间短、恢复快、留置尿管时间短等优点，尤其适用于无法行开放手术或TURP高龄高危患者。 ［关键词］ 前列腺增生；前列腺汽化手术；激光手术 Photoselective vaporization of prostate for the treatment of benign prostatic hyperplasia ［Abstract］ Objective To evaluate the safety and efficacy of photoselective vaporization of prostate(PVP)for the treatment of benign prostatic hyperplasia(BPH).Methods A total of 35 patients，the PVP via were under epidural anesthesia.Blood loss in the operation，operative time，indwelling catheterization，the sexual function.Results The PVP was successfully performed on all the 35 patients with BPH.There were 31 patients under epidural anesthesia and 4 patients under sacral anesthesia.The operative time was(range，19～112 min).All patients had minimal or no blood loss and no patients required blood transfution.The 8 cases with sexual function still remained potent postoperatively.All cases were followed for 1 month after treatment.The Qmax increased from（6.5±2.6）ml/s to （19.3±2.1）ml/s.Conclusion The PVP is an excellent treatment modality for BPH.It can yield rapid，safe and effective relief for patients with obstructive BPH with minimal invasion，especially for those at TURP advanced age or at high risk. ［Key words］ prostatic hyperplasia;vaporization prostatectomy;laser surgery 选择性绿激光前列腺汽化术（greenlight photoselective vaporization of prostate，PVP）是最近几年开展治疗前列腺增生症（BPH）的腔内手术。我院于2005年11月在浙江开展首例PVP以来，至2006年5月治疗BPH患者35例，效果满意，现报告如下。 1 资料与方法 1.1 一般资料 本组35例，年龄50～92岁，平均71岁。急性尿潴留7例，均为留置尿管者，无耻骨上造瘘者，合并膀胱结石3例，高血压者8例，慢性支气管炎合并肺气肿7例，糖尿病者4例，房室传导阻滞3例，脑萎缩者1例，腰椎外伤后1例。B超测 定前列腺重量约22～117 g，平均69.5 g，患者术前均检查尿流率测定、前列腺特异性抗原（PSA）、前列腺非特异性抗原（FPSA），直