铥激光联合膀胱软镜治疗高危前列腺增生合并膀胱憩室结石疗效观察
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摘要
目的:探讨铥激光联合膀胱软镜治疗高危前列腺增生症合并膀胱憩室结石的疗效及安全性。方法:回顾性分析我科2011年1月至2015年7月收治的22例高危前列腺增生症合并膀胱憩室结石患者临床资料,所有病例均首先使用膀胱软镜行憩室检查并行软镜下铥激光碎石术,碎石完成后,撤出软镜,膀胱硬镜下铥激光汽化切除增生前列腺组织。分别统计碎石时间及总手术时间,观察术中、术后并发症发生情况。统计患者术前国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Q_(max))、膀胱残尿量(PVR)并于术后6个月进行随访。结果:22例患者均手术成功,无明显术中、术后并发症发生,平均碎石时间20.3min,手术总体时间平均98min,术后4d拔除尿管,患者均排尿畅,无尿失禁。术后6个月随访,IPSS评分由术前(26.30±3.12)分降至(8.11±3.43)分,QOL评分由术前(7.55±3.15)分降至(1.74±0.93)分,差异有统计学意义(P<0.01);Q_(max)由术前(7.22±2.63)mL/s增至术后(14.84±1.56)mL/s,PVR由术前(21.71±6.51)mL降至术后(5.26±7.81)mL,差异有统计学意义(P<0.01)。结论:应用铥激光联合膀胱软镜治疗合并膀胱憩室结石的高危前列腺增生患者使手术效率提高,更加安全,值得进一步推广。
Objectives: To evaluate the clinical efficacy and safety of Thulium laser combined with flexible cystoscope for the treatment of benign prostatic hyperplasia(BPH) complicated with calculus in diverticulum of bladder. Methods: A review was conducted on 22 patients in our hospital from January 2011 to July 2015. The complications and the IPSS scores and QOL scores of all patients were recorded. All the patients were followed up for 6 months. The Qmax and PVR per-and post-operation was compared to evaluate the effectiveness. Results:All operations were successful,without serious complications. The improvements of IPSS and QOL scores in the two groups were significant(P = 0. 00). The Qmax changed from(7. 22 ± 2. 63) ml/s at per-operation to(14. 84 ±1. 56) ml/s at 6 months after operation. PVR changed from(21. 71 ± 6. 51) ml at per-operation to(5. 26 ±7. 81) ml at 6 months after operation. All the changes were significant(P = 0. 00). Conclusion: Thulium laser combined with flexible cystoscope can safely and effectively treat BPH complicated with calculus in diverticulum of bladder,worthy of promotion in clinical.
Objectives: To evaluate the clinical efficacy and safety of Thulium laser combined with flexible cystoscope for the treatment of benign prostatic hyperplasia(BPH) complicated with calculus in diverticulum of bladder. Methods: A review was conducted on 22 patients in our hospital from January 2011 to July 2015. The complications and the IPSS scores and QOL scores of all patients were recorded. All the patients were followed up for 6 months. The Qmax and PVR per-and post-operation was compared to evaluate the effectiveness. Results:All operations were successful,without serious complications. The improvements of IPSS and QOL scores in the two groups were significant(P = 0. 00). The Qmax changed from(7. 22 ± 2. 63) ml/s at per-operation to(14. 84 ±1. 56) ml/s at 6 months after operation. PVR changed from(21. 71 ± 6. 51) ml at per-operation to(5. 26 ±7. 81) ml at 6 months after operation. All the changes were significant(P = 0. 00). Conclusion: Thulium laser combined with flexible cystoscope can safely and effectively treat BPH complicated with calculus in diverticulum of bladder,worthy of promotion in clinical.
引文
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[6]吴敏红,余知灵,顾红勇,等.经电切镜外鞘输尿管镜气压弹道碎石治疗膀胱结石的改良.中国内镜杂志,2013,19(6):660.
[7]孙峰,孙新成,颉亮,等.铥激光联合第四代EMS碎石清石系统同期治疗高危BPH合并膀胱结石疗效分析.临床泌尿外科杂志,2015,30(8):717-719.
[8]Hai MA.Photoselective vaporization of prostate:five-year outcomes of entire clinic patient population.Urology,2009,73(4):807-810.
[9]林峰,陈军,王鸿康.经尿道前列腺电切术加钬激光碎石术治疗前列腺增生伴膀胱结石.临床泌尿外科杂志,2012,27(5):396-397.
[10]Fried NM.High-Power laser vaporization of the canine prostate using a 110W Thulium fiber at 1.91μm.Lasers Surg Med,2005,36(1):52-56.
[11]李春风,杨龙,栾祖乾,等.经尿道2μm激光治疗膀胱结石的疗效观察.临床泌尿外科杂志,2014,29(5):399-404.
[12]Fried NM,Murray KE.High-Power thulium fiber laser ablation of urinary tissues at 1.94μm.J Endourol,2005,19(1):25-31.
[13]刘春来,薛东炜,刘屹立,等.铥激光与绿激光治疗80g以上高龄高危BPH的疗效比较.中华男科学杂志,2011,13(5):431-434.
[14]洪锴,刘余庆,卢剑,等.钬激光与铥激光前列腺剜除术的效果以及对勃起功能影响的比较研究.中华男科学杂志,2015,21(3):245-250.
[15]Hauser S,Rogenhofer S,Ellinger J,et al.Thulium laser(Revolix)vapoenucleation of the prostate is a safe procedure in patients with an increased risk of hemorrhage.Urol Int,2012,88(4):390-394.
[16]刘春晓,郑少波.实用经尿道手术学.北京:人民卫生出版社,2011:111-113.
[17]Fabrizio L,Domenico P,Giovanni DL,et al.Efficacy and safety profile of a novel technique,Thul EP(Thulium laser enucleation of the prostate)for the treatment of benign prostate hypertrophy.Our experience on 148 patients.BMC Surg,2012,12(1):S21.
[2]Eyraud R,Laydner H,Autorino R,et al.Robot-assisted laparoscopic bladder diverticulectomy.Curr Urol Rep,2013,14(1):485-492.
[3]王振宇,徐文坚.人体断面与影像解剖学.第3版.北京:人民卫生出版社,2010:205-206.
[4]Moreno SJ,Galante-Romo I,Ortiz-Oshiro E,et al.Bladder di-verticulum robotic surgery:systematic review of case reports.Urol Int,2010,85(4):381-385.
[5]黄洪.经尿道输尿管镜弹道碎石术和大力钳碎石术用于提高膀胱憩室结石疗效比较.吉林医学,2015,36(14):3002-3003.
[6]吴敏红,余知灵,顾红勇,等.经电切镜外鞘输尿管镜气压弹道碎石治疗膀胱结石的改良.中国内镜杂志,2013,19(6):660.
[7]孙峰,孙新成,颉亮,等.铥激光联合第四代EMS碎石清石系统同期治疗高危BPH合并膀胱结石疗效分析.临床泌尿外科杂志,2015,30(8):717-719.
[8]Hai MA.Photoselective vaporization of prostate:five-year outcomes of entire clinic patient population.Urology,2009,73(4):807-810.
[9]林峰,陈军,王鸿康.经尿道前列腺电切术加钬激光碎石术治疗前列腺增生伴膀胱结石.临床泌尿外科杂志,2012,27(5):396-397.
[10]Fried NM.High-Power laser vaporization of the canine prostate using a 110W Thulium fiber at 1.91μm.Lasers Surg Med,2005,36(1):52-56.
[11]李春风,杨龙,栾祖乾,等.经尿道2μm激光治疗膀胱结石的疗效观察.临床泌尿外科杂志,2014,29(5):399-404.
[12]Fried NM,Murray KE.High-Power thulium fiber laser ablation of urinary tissues at 1.94μm.J Endourol,2005,19(1):25-31.
[13]刘春来,薛东炜,刘屹立,等.铥激光与绿激光治疗80g以上高龄高危BPH的疗效比较.中华男科学杂志,2011,13(5):431-434.
[14]洪锴,刘余庆,卢剑,等.钬激光与铥激光前列腺剜除术的效果以及对勃起功能影响的比较研究.中华男科学杂志,2015,21(3):245-250.
[15]Hauser S,Rogenhofer S,Ellinger J,et al.Thulium laser(Revolix)vapoenucleation of the prostate is a safe procedure in patients with an increased risk of hemorrhage.Urol Int,2012,88(4):390-394.
[16]刘春晓,郑少波.实用经尿道手术学.北京:人民卫生出版社,2011:111-113.
[17]Fabrizio L,Domenico P,Giovanni DL,et al.Efficacy and safety profile of a novel technique,Thul EP(Thulium laser enucleation of the prostate)for the treatment of benign prostate hypertrophy.Our experience on 148 patients.BMC Surg,2012,12(1):S21.