高功率双波长龙激光汽化术治疗良性前列腺增生

吴忠; 高鹏; 王路加; 茅善华; 张元芳; 沈周俊; 丁强

doi:10.13201/j.issn.1001-1420.2017.04.003

高功率双波长龙激光汽化术治疗良性前列腺增生

- 复旦大学附属华山医院泌尿外科, (上海, 200040)

详细信息

通讯作者: 沈周俊, E-mail:hmgsh188@126.com

中图分类号: R697.3

收稿日期: 2017-02-14

High power dual ceralas laser vaporization for benign prostatic hyperplasia

- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China

More Information

Corresponding author: SHEN Zhoujun, E-mail: hmgsh188@126.com

Received Date: 14 February 2017

摘要

摘要: 目的:探讨高功率双波长 (980nm/1 470nm) 龙激光汽化术治疗BPH的疗效及其安全性。方法:2015年8月~2016年8月应用高功率双波长 (980nm/1 470nm) 龙激光汽化术对我院收治的的58例BPH患者进行了治疗。应用直射光纤接触式汽化及“扫雪技术”, 将前列腺部尿道汽化消融成类似于TURP术后的宽敞腔道。分别对患者术前、术后3个月及6个月的前列腺体积 (经直肠超声) 、国际前列腺症状评分 (IPSS) 、最大尿流率 (Q_max) 、剩余尿量 (PVR) 和生活质量评分 (QOL) 等进行前瞻性分析研究, 并评估该技术的并发症发生情况。结果:术后3个月随访显示, 前列腺体积明显缩小[术前 (45.6±27.7) ml vs.术后 (28.6±12.2) ml, P=0.000], IPSS明显降低术前[ (23.7±5.6) vs.术后 (8.1±3.8) , P=0.000], Q_max显著增加[术前 (8.2±3.1) ml/s vs术后 (20.0±2.3) ml/s, P=0.000) ], PVR明显减少[术前 (170.2±115.5) ml vs.术后 (33.6±26.9) ml, P=0.000) ], QOL明显改善[术前 (4.7±1.1) vs.术后 (2.2±0.9) , P=0.000]。术后6个月, 此5项主、客观参数都有进一步改善。术中、术后无输血, 也无其他严重并发症发生。术后最常见并发症为尿路刺激症状:本组为15例 (25.9%), 多于术后2周消失。3例急迫性尿失禁, 于术后2周~1个月左右恢复。结论:我们首次报道高功率双波长 (980nm/1470nm) 龙激光汽化术治疗BPH, 可明显改善IPSS、Qmax、PVR和QOL, 且并发症轻微。该技术为BPH的激光治疗带来了新方法, 值得进一步研究。
- 良性前列腺增生 /
- 双波长激光 /
- 激光 /
- 汽化术
Abstract: Objective:To evaluate the efficiency and safety of vaporization of the high power dual ceralas (980nm/1 470nm) laser for treatment of BPH.Method:A total of 58 patients with BPH were included in the study.Preoperative prostate volume (through TRUS), international prostate symptom score (IPSS), maximal flow rate (Q_max), post-voided residual urine (PVR) and quality of life (QOL) were compared at three and six months postoperatively.Complications were also assessed.Contact vaporization with "sweeping snow"technique was used to give a TURP-like cavity.Postoperative irrigation was not used routinely.Result:Postoperative three-month follow-up revealed that prostate volume decreased from (45.6±27.7) ml to (28.6±12.2) ml, P=0.000, and IPSS decreased from (23.7±5.6) to (8.1±3.8), P=0.000.The mean Q_maxincreased significantly from (8.2±3.1) ml/s to (20.0±2.3) ml/s, P=0.000.PVR decreased significantly from (170.2±115.5) ml to (33.6±26.9) ml, P=0.000.QOL changed considerably compared to baseline.All of these values showed slight improvement at six-month follow-up.No blood transfusion or other severe complications were encountered during and after the procedures.The most common postoperative complications were irritative symptoms (15of 58, or 25.9%) which subsided at two weeks.Three patients had temporary combined urge and stress incontinence for two weeks to one month.Conclusion:The high power dual ceralas (980nm/1 470nm) laser vaporization provided significant improvements in IPSS, Q_max, PVR and QOL with low morbidity.These results of prostatic vaporization with the high power dual ceralas (980nm/1 470nm) laser, representing what is to our knowledge the first clinical study in the literature, are encouraging and needs to be further elucidated.
- benign prostatic hyperplasia /
- dual laser /
- laser /
- vaporization techniques

HTML全文

参考文献(20)

[1]	Djavan B, Eckersberger E, Finkelstein J, et al.Benign prostatichyperplasia:current clinical practice[J].Prim Care, 2010, 37 (3):583-597.
[2]	Tammela T.Benign prostatic hyperplasia.Practical treatment guidelines[J].Drugs Aging, 1997, 10 (5):349-366.
[3]	Reich O, Gratzke C, Bachmann A, et al.Morbidity, mortaility and early outcome of transurethral resection of the prostate:a prospective, multicenter evaluation in10654 patients[J].J Urol, 2008, 180 (1):246-249.
[4]	Wezel F, Wendt-Nordahl G, Huck N, et al.New alternatives for laser vaporization of the prostate:experimental evaluation of a 980-, 1, 318-and 1, 470-nm diode laser device[J].World J Urol, 2010, 28 (2):181-186.
[5]	Seitz M, Ruszat R, Bayer T, et al.Ex vivo and in vivo investigations of the novel 1, 470nm diode laser for potential treatment of benign prostatic enlargement[J].Lasers Med Sci, 2009, 24 (3):419-424.
[6]	Wendt-Nordah G, Huckele S, Honeck P, et al.980-nm Diode laser:a novel laser technology for vaporization of the prostate[J].Eur Urol, 2007, 52 (6):1723-1728.
[7]	Erol A, Cam K, Tekin A, et al.High power ceralas laser vaporization of the prostate:preliminary results for benign prostatic hyperplasia[J].J Urol, 2009, 182 (3):1078-1082.
[8]	Zhao Y, Liu C, Zhou G, et al.A Retrospective Evaluation of Benign Prostatic Hyperplasia Treatment by Transurethral Vaporization Using a 1 470nm Laser[J].Photomed Laser Surg, 2013, 31 (12):626-629.
[9]	张明聪, 张传杰, 朱俊栋, 等.1 470nm半导体激光汽化剜除术治疗前列腺增生的疗效[J].中华临床医师杂志 (电子版), 2016, 10 (19):2863-2866.
[10]	Muir G, Gomez F, Choi B, et al.Multicenter prospective study of evolve:dual 150 wlaser for bladder outflow obstruction:preliminary results[J].Urology, 2011, 78 (supplement3A):S59
[11]	Rosenthal B D, DiTrolio J V.Photoselective vaporization of the prostate in office and outpatient settings[J].Can J Urol, 2012, 19 (2):6223-6226.
[12]	那彦群, 叶章群, 孙颖浩, 等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社, 2014:259.
[13]	Gnessin E, Mandeville J A, Lingeman J E.An update on holmium laser enucleation of the prostate and why it has stood the test of time[J].Curr Opin Urol, 2011, 21 (1):31-35.
[14]	Saito T, Honda N, Saito H.Advantage and disadvantage of KTP-532laser tonsillectomy compared with conventional method.Auris[J].Auris Nasus Larynx, 1999, 26 (4):447-452.
[15]	Leonardi R, Cahabiano R, Lanzafame S.Histological evaluation of prostatic tissue following transurethral laser resection (TULaR) using the 980nm diode laser[J].Arch Ital Urol Androl, 2010, 82 (1):1-4.
[16]	Wendt-Nordahl G, Huckele S, Honeck P, et al.980-nm Diode laser:a novel laser technology for vaporization of the prostate[J].Eur Urol, 2007, 52 (6):1723-1728.
[17]	Seitz M, Ackermann A, Gratzke C, et al.Diode laser.Ex vivo studies on vaporization and coagulation characteristics[J].Urologe A, 2007, 46 (9):1242-1247.
[18]	Erol A, Cam K, Tekin A, et al.High power diode laser vaporization of the prostate:preliminary results for benign prostatic hyperplasia[J].J Urol, 2009, 182 (3):1078-1082.
[19]	Ruszat R, Seitz M, Wyler S F, et al.Prospective singlecentre comparison of 120-W diodepumped solid-state high-intensity system laser vaporization of the prostate and 200-W highintensive diode-laser ablation of the prostate for treating benign prostatic hyperplasia[J].BJU Int, 2009, 104 (6):820-825.
[20]	Wezel F, Wendt-Nordahl G, Huck N, et al.New alternatives for laser vaporization of the prostate:experimental evaluation of a 980-, 1, 318-and 1, 470-nm diode laser device[J].World J Urol, 2010, 28 (2):181-186.