摘要
目的探讨1064 nm超脉冲激光经尿道前列腺剜除术治疗前列腺增生的安全性和临床疗效。方法2018年8月至2019年8月在我院泌尿外科住院的82例前列腺增生患者,前列腺体积(73±25)ml(41~159)ml,均行1064 nm超脉冲激光经尿道前列腺剜除术治疗。手术方法:在平精阜外左侧5点于外括约肌近侧处用镜鞘侧压裂开加镜鞘弧形逆推的方式找到前列腺外科包膜平面,用1064 nm超脉冲激光进行汽化切割和止血,采用整体剜除或者分叶剜除方法,将腺体标本推入膀胱腔,组织粉碎器粉碎腺体吸出体外。随访3个月。结果本组82例患者均顺利完成手术,剜除腺体时间(36±10)min(24~61 min),组织粉碎时间(11±6)min(5~51 min),切除腺体组织质量(60±21)g(31~124)g,手术时间(80±28)min(55~148 min),血红蛋白下降(17±8)g/L(3~34)g/L,无输血患者。术后留置导尿管时间(5.3±1.5)d。术后随访3个月,IPSS、QOL、Qmax、RUV均较术前明显改善(P<0.01)。拔出尿管后第1天7例患者出现暂时性尿失禁,经盆底肌锻炼1周后4例恢复控尿,2周后2例恢复,4周后全部恢复尿控,没有患者发生尿道狭窄及膀胱颈挛缩。结论1064 nm超脉冲激光具有良好的止血和组织汽化切割效果,经尿道前列腺剜除术能够有效地切除增生腺体,止血高效彻底,是一种安全有效的手术方式。
Objective To investigate the clinical safety and efficacy of transurethral 1064nm super pulse laser enucleation of the prostate for benign prostatic hyperplasia(BPH).Methods From August 2018 to August 2019,82 patients with BPH were hospitalized in urology deparrtment of our hospital.The average volume of prostate was(73±25)ml(41-159)ml.The surgical envelope of the prostate was found at 5 o'clock on the left side of the outer sphincter from the proximal side of the outer sphincter.Vaporization and hemostasis were used by 1064 nm super pulse laser.After whole enucleation or lobulating enucleation,glandular specimens were pushed into bladder cavity.All patients were followed up for 3 months.Results The average time of enucleation of glands was(36±10)min(24-61)min,the average time of tissue crushing was(11±6)min(5-51)min,the average mass of removed glandular tissue was(60±21)g(31-124)g and the average time of operation was(80±28)min(55-148)min,the average hemoglobin decreased was(17±8)g/L(3-34)g/L.None of the patients received blood transfusion.Catheter had been indwelling for(5.3±1.5)days.After 3 months of follow-up,IPSS,QOL,Qmax and RUV were significantly better than those before operation(P<0.01).On the first day after pulling out the catheter,7 patients had temporary urinary incontinence,4 cases recovered after 1 week of pelvic floor muscle exercise,2 cases recovered after 2 weeks,all recovered after 4 weeks.No patient had urethral stricture and bladder neck contracture.Conclusion 1064 nm super pulse laser has a good hemostatic and tissue vaporization cutting effect,transurethral enucleation of the prostate can effectively remove hyperplastic glands,it is a safe and effective surgical procedure for BPH.
作者
李浩勇
李琦
蒋焜
宁金卓
袁润
李成龙
周向军
阮远
饶婷
余伟民
程帆
Li Haoyong;Li Qi;Jiang Kun;Ning Jinzhuo;Yuan Run;Li Chenglong;Zhou Xiangjun;Ruan yuan;Rao Ting;Yu Weimin;Cheng Fan(Department of Urology,Renmin Hospital,Wuhan University,Hubei 430060,China)
出处
《中华腔镜泌尿外科杂志（电子版）》
2021年第1期29-32,共4页
Chinese Journal of Endourology(Electronic Edition)
