摘要
目的评价1 470nm双效激光前列腺汽化切除术治疗高龄高危良性前列腺增生症(BPH)的临床疗效及安全性。方法2017年7月至2018年6月福建省立金山医院收治1 470nm双效激光前列腺汽化切除术治疗的高龄高危BPH患者48例纳入研究,观察术后患者的症状缓解情况及并发症。观察指标包括国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、残余尿量、手术操作时间、术后膀胱冲洗时间、留置导尿管时间和术后住院时间等。结果 48例患者手术均顺利,均未出现电切综合征,无输血病例,无死亡病例,平均手术时间(51.4±11.2)min,平均出血量(29.4±16.3)ml,术后均留置导尿管行膀胱冲洗8～28h,平均(19.7±9.6)h,平均留置尿管时间(3.4±0.7)d,术后平均住院时间(4.2±1.8)d。术后3个月IPSS由术前的(27.8±4.5)分下降至(6.1±1.7)分、QOL评分由术前的(5.1±0.5)分下降至(1.5±0.7)分、Qmax从术前的(6.2±1.2)ml/s增加至(20.7±4.6)ml/s,残余尿量由术前的(87.4±47.7)ml下降至(20.6±12.9)ml,与术前比较,各指标均有明显改善(P<0.05)。中位随访时间2.8个月(1～4个月),未出现如膀胱痉挛、尿失禁等严重并发症。部分患者出现短暂性排尿困难、尿路刺激症状、继发性出血、短暂性急迫性尿失禁,给予对症治疗后均明显改善。结论 1 470nm双效激光前列腺汽化切除术治疗高龄高危BPH安全有效,是一种值得推荐的手术方式,其近期疗效显著,远期疗效有待进一步随访观察。
Objective To explore the efficacy and safety of 1 470 nm diode laser vaporization and resection of the prostate for benign prostatic hyperplasia(BPH)in high-risk elderly patients.Methods Consecutive patients with BPH in high-risk situation who underwent transurethral 1 470 nm diode laser vaporization and resection of the prostate at our institution from July 2017 to June2018 were reviewed.All data were collected including preoperative and postoperative change of symptoms,IPSS,QOL score,Qmax,RUV,and the time of operation,postoperative bladder irrigating,duration of catheterization,postoperative hospital stay. Results The mean operation time was(51.4±11.2)min,and the estimated blood loss was(29.4±16.3)ml.The median postoperative hospital stay and mean duration of catheterization were 4(3.8)d and(3.4±0.7)d,respectively.The mean preoperative IPSS,QOL score sore and Qmax and 3 month postoperative were(27.8±4.5)versus(6.1±1.7),(5.1±0.5)versus(1.5±0.7),and(6.2±1.2)versus(20.7±4.6)ml/s,respectively,with significant difference.No patient experienced postoperative complications such as incontinence or urethral stricture during a median follow-up period of 2.8 months(range 1 to4 months). Conclusions Transurethral 1 470 nm diode laser vaporization and resection of the prostate is safe and effective for treatment of BPH in high-risk situation which could provide rapid postoperative rehabilitation.
引文
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