Rezūm热蒸汽消融系统治疗良性前列腺增生的安全性和有效性被引量：3

Safety and efficacy of Rezūm water vapor thermal therapy system in the treatment of benign prostatic hyperplasia

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摘要目的探讨Rezim热蒸汽消融系统治疗良性前列腺增生(BPH)的有效性和安全性。方法回顾性分析2020年12月至2021年1月在海南博鳌一龄生命养护中心收治的22例BPH患者的临床资料。年龄(61.0±5.9)岁。前列腺体积(43.7±8.4)ml。国际前列腺症状评分(IPSS)(19.3±3.7)分,生活质量(QOL)评分(4.2±0.8)分。最大尿流率(Q_(max))(11.9±3.4)ml/s,残余尿量(PVR)(14.0±19.0)ml。19例有性生活者,术前国际勃起功能指数问卷表-5(IIEF-5)(17.0±5.5)分;男性性健康问卷-射精功能障碍评分(MSHQ-EjD)中射精功能评分(10.0±3.2)分,射精满意度评分(1.5±1.0)分。22例均采用Rezūm热蒸汽消融系统行经尿道前列腺热蒸汽消融术。Rezūm系统由可重复使用的热蒸汽治疗设备和一次性前列腺热蒸汽治疗器械组成。热蒸汽治疗设备利用射频能量将无菌蒸馏水加热,产生103℃高温水蒸汽,在9s的时间里将每个治疗区域内的组织温度提高约70℃,导致细胞死亡,从而使前列腺组织体积缩小。一次性前列腺热蒸汽治疗器械可置人膀胱镜,头端有可伸缩针尖,针尖伸出长度10.25mm,针尖上均匀分布12个孔,呈3列,每列4个孔,每列间距为120°,可实现热蒸汽沿圆周均匀扩散。静脉全麻,患者取截石位,采用置人膀胱镜的一次性前列腺热蒸汽治疗器械检查前列腺尿道、膀胱,评估前列腺两侧叶和中叶。治疗器械每个视野下的组织间长度为0.5cm,计算从膀胱颈部至精阜距离。于左侧叶膀胱颈部3点处外撤2个视野,注射第1针。释放热蒸汽时,针尖与前列腺尿道黏膜垂直,每针穿刺均向前列腺组织注入0.42ml无菌蒸馏水形成的热蒸汽。热蒸汽喷射持续9 s,等待2~3s后撤回针尖。每隔2个视野穿刺1针,依次注射至精阜近端尿道。同样方法治疗右侧叶。对于中叶增生明显者,于膀胱颈部外撤2个视野,并斜45°进针,根据中叶增生情况间隔2个视野注射第2针。观察各穿刺点无明显 Objective To evaluate the efficacy and safety of Rezūm Water Vapor Thermal Therapy system in the treatment of patients with benign prostatic hyperplasia(BPH).Methods The clinical data of 22 patients with benign prostatic hyperplasia treated with Rezūm Water Vapor Thermal Therapy system in Boao Yiling Life Care Center in Hainan from December 2020 to January 2021 were retrospectively analyzed,with age of(61.0±5.9)years,prostate volume of(43.7±8.4)ml.international prostate symptom score(IPSS)of(19.3±3.7),quality of life(QOL)score of(4.2±0.8),maximum urinary flow rate(Q_(max))of(11.9±3.4)ml ml/s,and residual urine volume(PVR)of(14.0±19.0).For 19 patients with sexual life,the International Index of Erectile Function Questionnaire-5(IIEF-5)were 17.0±5.5,the Mens Sexual Health Questionnaire-Ejaculatory Dysfunction Score(MSHQ-EjD)ejaculatory function score were 10.0±3.2,and the ejaculatory satisfaction score were 1.5±1.0.Twenty-two patients underwent Rezūm Water Vapor Thermal Therapy under intravenous anesthesia(general anesthesia without intubation)in the dorsal lithotomy position.The Rezūm system consisted of reusable thermal steam treatment device and disposable prostate thermal steam treatment instrument.The thermal steam treatment device used radiofrequency energy to heat sterile distilled water,generating hightemperature steam at 103℃.In a 9-second timeframe,the tissue temperature within each treatment area was raised approximately 70℃,causing cell death and resulting in a shrink in prostate tissue volume.The disposable prostate thermal steam treatment instrument could be inserted through a cystoscope and had a retractable needle tip that extends to a length of 10.25 mm.The needle tip had 12 evenly distributed holes arranged in three rows of four holes each,with a spacing of 120o between rows,allowing for even diffusion of thermal steam along the circumference.The patient was placed in a lithotomy position,and the disposable prostate thermal steam treatment instrument was used to examine the prosta

作者薛波新孙杰江春陈刚杨海峰刘明 Xue Boxin;Sun Jie;Jiang Chun;Chen Gang;Yang Haifeng;Liu Ming(Department of Urology,the Second Afiliated Hospital of Soochow University,Suzhou 215004,China;Department of Urology,Renji Hospital,Affliated of Shanghai Jiaotong University of Medicine,Shanghai 200127,China;Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;Department of Urology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Urology,Boao YiLings Life Conservation Center,Qionghai 571437,China;Department of Urology,Beijing Hospital,Beijing 100730,China)