Application and preliminary experience of super pulsed thulium fiber laser in enucleation of prostate
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摘要: 目的 分析超脉冲光纤铥激光前列腺剜除术(SPThuFLEP)治疗前列腺增生(BPH)的安全性和有效性，探索SPThuFLEP最佳的参数组合。方法 回顾性分析2022年11月—2022年12月因BPH行SPThuFLEP患者的临床资料，SPThuFLEP全部采用“三叶法”，剜除用脉冲波，平均功率为55 W，止血用连续波，平均功率为60 W，脉冲波参数设置为3组：①1 J×55 Hz；②1.5 J×36.7 Hz；③2 J×27.5 Hz。观察术前与术后国际前列腺症状评分(IPSS)、生活质量评分(QoL)、最大尿流率(Qmax)变化，分析不同参数组剜除效率及手术疗效差异。结果 纳入18例患者，平均年龄(70.5±2.3)岁，全部完成手术及术后随访。平均剜除手术时间(75.0±5.3) min，平均止血时间(5.8±0.4) min，平均剜除组织重量(47.9±5.6) g，平均剜除效率(0.6±0.05) g/min，无术中并发症发生；术后第1天平均血红蛋白下降值(6.3±1.1) g/dL，平均留置尿管时间(4.4±0.3) d，术后3个月随访时，平均Qmax(22.6±0.8) mL/s，平均IPSS评分(4.3±0.8)分，平均QoL评分(0.9±0.2)分；1例患者出现反复尿路感染，3例有性生活患者均出现逆向射精，无长期尿失禁、尿道狭窄等并发症。结论 SPThuFLEP治疗BPH安全有效，不同参数设置对SPThuFLEP效率及效果的影响不大。Abstract: Objective To analyze the safety and effectiveness of super pulsed thulium fiber laser enucleation of prostate (SPThuFLEP) in the treatment of benign prostatic hyperplasia (BPH), and to explore the optimal parameter in SPThuFLEP.Methods We retrospectively analysed the data of patients who received SPThuFLEP due to BPH from November 2022 to December 2022. All patients were treated with 'three-leaf' method SPThuFLEP, with pulse wave for enucleation (55 W) and continuous wave for hemostasis (60 W). Pulse wave parameters were set as 1 J×55 Hz, 1.5 J× 36.7 Hz, 2 J×27.5 Hz respectively. The changes of international prostate symptom score (IPSS), quality of life (QoL) score and maximum urinary flow rate (Qmax) before and after operation were observed. Enucleation efficiency and surgical efficacy were analyzed in different parameter groups.Results A total of 18 patients were included, with an average age of (70.5±2.3) years. All patients completed the operation and were followed up after the operation. The mean time of enucleation was (75.0±5.3) min, and the mean time of hemostasis was (5.8±0.4) min. The mean tissue weight of enucleation was (47.9±5.6) g, and the mean enucleation efficiency was (0.6±0.05) g/min. No intraoperative complications occurred. On the first day after surgery, the mean hemoglobin decreased (6.3±1.1) g/dL. The mean catheterization time was (4.4±0.3) days. Postoperative three-month follow-up results showed the mean Qmax was (22.6±0.8) mL/s, the mean IPSS score was (4.3±0.8), and the mean QoL score was (0.9±0.2). One patient had recurrent urinary tract infection, and all the 3 patients who had sexual life had reverse ejaculation. No long-term urinary incontinence, urethral stricture or other complications were found.Conclusion SPThuFLEP is safe and effective in treating BPH. Different parameter settings have little influence on the efficiency and effect of SPThuFLEP.
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表 1 排尿功能手术前后变化
X±S 项目 术前 术后 术后较术前改善 P值 Qmax/(mL/s) 7.6±0.4 22.6±0.8 15.0±0.8 < 0.001 IPSS评分 20.1±0.7 4.3±0.8 15.7±1.0 < 0.001 QoL评分 4.8±0.1 0.9±0.2 3.9±0.3 < 0.001 
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表 2 不同激光参数组别间术前差异
X±S 组别 年龄/岁 前列腺体积/mL Qmax/(mL/s) PSA/(ng/mL) PVR/mL IPSS/分 QoL/分 术前血红蛋白/(g/L) A组(6例) 72.2±3.4 77.8±11.9 7.6±0.6 3.9±1.2 40.8±8.8 18.8±1.0 4.8±0.3 148.0±4.5 B组(6例) 70.2±4.6 79.4±12.9 7.5±1.0 7.4±2.6 92.5±38.8 21.3±1.4 4.8±0.3 132.3±4.8 C组(6例) 69.3±4.8 75.2±14.1 7.8±0.5 6.3±2.9 44.3±21.6 20.0±0.9 4.8±0.2 128.2±7.3 F值 0.112 0.027 0.050 0.550 1.222 1.192 < 0.001 3.398 P值 0.895 0.973 0.952 0.588 0.322 0.331 1.000 0.061
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表 3 不同激光参数组间术中与术后差异
X±S 组别 剜除时间/min 剜除腺体重量/g 剜除效率/(g/min) 术后尿管留置时间/d 术前第1天血红蛋白/(g/L) 术后3个月Qmax/(mL/s) 术后3个月IPSS/分 术后3个月QoL/分 A组(6例) 71.6±11.1 53.2±10.9 0.73±0.09 4.0±0.2 141.3±4.2 21.3±1.0 3.8±0.3 1.2±0.4 B组(6例) 84.2±9.5 45.0±8.0 0.52±0.05 4.6±0.5 125.6±5.9 23.8±1.4 3.8±0.3 0.6±0.2 C组(6例) 69.2±7.2 45.5±11.4 0.61±0.10 4.5±0.5 122.5±5.5 22.8±1.7 5.3±0.6 0.8±0.6 F值 0.724 0.200 1.372 0.520 3.652 0.831 0.390 0.307 P值 0.501 0.821 0.284 0.605 0.051 0.455 0.684 0.740
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[1] Hartung FO, Kowalewski KF, von Hardenberg J, et al. Holmium Versus Thulium Laser Enucleation of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials[J]. Eur Urol Focus, 2022, 8(2): 545-554. doi: 10.1016/j.euf.2021.03.024
[2] 刘敏, 高小峰. 铥光纤激光碎石基础研究和临床应用进展[J]. 中华泌尿外科杂志, 2021, 42(1): 75-78. doi: 10.3760/cma.j.cn112330-20200907-00655
[3] Rassweiler J, Teber D, Kuntz R, et al. Complications of transurethral resection of the prostate(TURP)-incidence, management, and prevention[J]. Eur Urol, 2006, 50(5): 969-979. doi: 10.1016/j.eururo.2005.12.042
[4] 陈佳炜, 海波, 董伟, 等. 钬激光前列腺剜除术和经尿道前列腺电切术治疗良性前列腺增生疗效和安全性的Meta分析[J]. 临床泌尿外科杂志, 2021, 36(6): 431-438. doi: 10.13201/j.issn.1001-1420.2021.06.002
[5] Enikeev D, Netsch C, Rapoport L, et al. Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate[J]. Int J Urol, 2019, 26(12): 1138-1143. doi: 10.1111/iju.14115
[6] Enikeev D, Okhunov Z, Rapoport L, et al. Novel Thulium Fiber Laser for Enucleation of Prostate: A Retrospective Comparison with Open Simple Prostatectomy[J]. J Endourol, 2019, 33(1): 16-21. doi: 10.1089/end.2018.0791
[7] Elmansy H, Hodhod A, Elshafei A, et al. Comparative analysis of MOSESTM technology versus novel thulium fiber laser(TFL)for transurethral enucleation of the prostate: A single-institutional study[J]. Arch Ital Urol Androl, 2022, 94(2): 180-185. doi: 10.4081/aiua.2022.2.180
[8] Bozzini G, Berti L, Maltagliati M, et al. Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences?[J]. World J Urol, 2023, 41(1): 143-150.
[9] Petov V, Babaevskaya D, Taratkin M, et al. Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid-and Long-Term Outcomes in 1328 Patients[J]. J Endourol, 2022, 36(9): 1231-1236. doi: 10.1089/end.2022.0029
[10] 安子彦, 符伟军, 宋勇, 等. 经尿道前列腺铥光纤激光分叶剜除术后下尿路症状对生活质量的影响[J]. 临床泌尿外科杂志, 2022, 37(10): 773-777. doi: 10.13201/j.issn.1001-1420.2022.10.010 https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2022.10.010
[11] Becker B, Enikeev D, Glybochko P, et al. Effect of optical fiber diameter and laser emission mode(cw vs pulse)on tissue damage profile using 1.94 μm Tm: fiber lasers in a porcine kidney model[J]. World J Urol, 2020, 38(6): 1563-1568. doi: 10.1007/s00345-019-02944-y
[12] Doizi S, Germain T, Panthier F, et al. Comparison of Holmium: YAG and Thulium Fiber Lasers on Soft Tissue: An Ex Vivo Study[J]. J Endourol, 2022, 36(2): 251-258. doi: 10.1089/end.2021.0263
[13] Kim JK, Cho MC, Son H, et al. Patient Perception of Ejaculatory Volume Reduction After Holmium Laser Enucleation of the Prostate(HoLEP)[J]. Urology, 2017, 99: 142-147. doi: 10.1016/j.urology.2016.09.037
[14] Kim M, Song SH, Ku JH, et al. Pilot study of the clinical efficacy of ejaculatory hood sparing technique for ejaculation preservation in Holmium laser enucleation of the prostate[J]. Int J Impot Res, 2015, 27(1): 20-24. doi: 10.1038/ijir.2014.22
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