1470nm半导体激光联合腹腔镜治疗前列腺增生合并膀胱憩室(附6例报告)
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摘要
目的探讨经尿道1 470nm半导体激光前列腺汽化切除术联合腹腔镜下膀胱憩室切除术同期治疗前列腺增生合并膀胱憩室的可行性和优越性。方法回顾性地分析自2017年8月至2018年2月我科收治的应用经尿道1 470nm半导体激光前列腺汽化切除术联合腹腔镜下膀胱憩室切除术同期治疗前列腺增生合并膀胱憩室6例患者的临床资料。结果 6例手术均成功完成,无中转开放手术,平均手术时间为(206.3±19.54)(185～240)min,术中出血量平均为(69.2±18.01)(50～100)mL,术后平均膀胱冲洗时间为(15.8±5.67)(8～22)h,平均住院时间为(8.5±1.05)(7～10)d。术后3个月随访患者排尿症状明显改善,平均最大尿流率为(19.9±3.06)(16.8～25.2)mL/s,平均残余尿为(19.2±8.01)(10～30)mL,术后无相关并发症发生。结论经尿道1 470nm半导体激光前列腺汽化切除术联合腹腔镜下膀胱憩室切除术同期治疗前列腺增生合并膀胱憩室是一种安全、可行的手术方法,由于其手术创伤小、出血少、患者恢复快,具有一定的优越性。
Objective To evaluate the safety and feasibility of 1 470 nm diode laser vaporesection of prostate(DiLVaRP)and laparoscopic bladder diverticulectomy(LBD)in the treatment of concomitant benign prostatic hyperplasia(BPH)and bladder diverticula.Methods The clinical data of 6 cases of concomitant BPH and bladder diverticula treated with DiLVaRP and LBD during Aug.2017 and Feb.2018 were retrospectively analyzed.Results All procedures were successfully performed,and no cases converted to open surgery.The average operation time,blood loss,bladder irrigation time and hospitalization time were 206.3±19.54(185-240)min,69.2±18.01(50-100)mL,15.8±5.67(8-22)h,and 8.5±1.05(7-10)d,respectively.No serious complications were observed after operation.Three months after surgery,the urination symptoms were significantly improved;the average maximum urinary flow rate(Qmax)and post void residual volume(PVR)were 19.9±3.06(16.8-25.2)mL/s and 19.2±8.01(10-30)mL,respectively.Conclusion DiLVaRP combined with LBD is a safe and feasible approach in the treatment of concomitant BPH and bladder diverticula,which has advantages of small trauma,little blood loss and few complications.
Objective To evaluate the safety and feasibility of 1 470 nm diode laser vaporesection of prostate(DiLVaRP)and laparoscopic bladder diverticulectomy(LBD)in the treatment of concomitant benign prostatic hyperplasia(BPH)and bladder diverticula.Methods The clinical data of 6 cases of concomitant BPH and bladder diverticula treated with DiLVaRP and LBD during Aug.2017 and Feb.2018 were retrospectively analyzed.Results All procedures were successfully performed,and no cases converted to open surgery.The average operation time,blood loss,bladder irrigation time and hospitalization time were 206.3±19.54(185-240)min,69.2±18.01(50-100)mL,15.8±5.67(8-22)h,and 8.5±1.05(7-10)d,respectively.No serious complications were observed after operation.Three months after surgery,the urination symptoms were significantly improved;the average maximum urinary flow rate(Qmax)and post void residual volume(PVR)were 19.9±3.06(16.8-25.2)mL/s and 19.2±8.01(10-30)mL,respectively.Conclusion DiLVaRP combined with LBD is a safe and feasible approach in the treatment of concomitant BPH and bladder diverticula,which has advantages of small trauma,little blood loss and few complications.
引文
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[3]FOX M,POWER RF,BRUCE AW.Diverticulum of the bladder presentation and evaluation of treatment of 115cases[J].Br J Urol,1962,34(3):286-298.
[4]PARRA RO,BOULLIER JA.Endocavitary laparoscopic bladder surgery[J].Semin Urol,1992,10(4):213-221.
[5]TAREEN BU,MUFARRIJ PW,GODOY G,et al.Robot-assisted laparoscopic partial cystectomy and diverticulectomy:initial experience of four cases[J].J Endourol,2008,22(7):1497-1500.
[6]Ryan AC,Gamal MG.Transurethral electrovaporization of bladder diverticulum:An alternative to open or laparoscopic bladder diverticulectomy[J].J Endourol,2015,1:11-13.
[7]DIEGO ANTONIO PRECIADO-ESTRELLA,PASCUAL CORTES-RAYGOZA,JORGE GUSTAVO MORALES-MONTOR,et al.Multiple bladder diverticula treated with robotic approachassisted with cystoscopy[J].Urol Annals,2018,10:114-117.
[8]IITER TUFEK,PANAGIOTIS MOURMOURIS,OMER BURAK ARGUN,et al.Robot-assisted bladder diverticulectomy with concurrent management of bladder outlet obstruction[J].Urol Int,2016,96:432-437.
[9]RASSWEILER J,TEBER D,KUNTZ R,et al.Complication of transurethral resection of the prostate(TURP)-incidence,management,and prevention[J].Eur Urol,2006,50:969-979.
[10]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.
[11]章俊,王曦龙,史朝亮,等.1 470nm半导体激光前列腺汽化剜除术治疗复杂性良性前列腺增生(附80例报告)[J].现代泌尿外科杂志,2017,22(3):173-175.
[12]MICHALAK J,TZOU D,FUNK J.HoLEP:the gold standard for the surgical management of BPH in the 21st century[J].Am J Clin Exp Urol,2015,3(1):36-42.
[2]MORENO SJ,GALANTE RI,ORTIZ OE,et al.Bladder diverticulum robotic surgery:systematic review of case report[J].Urol Int,2010,85(4):381-385.
[3]FOX M,POWER RF,BRUCE AW.Diverticulum of the bladder presentation and evaluation of treatment of 115cases[J].Br J Urol,1962,34(3):286-298.
[4]PARRA RO,BOULLIER JA.Endocavitary laparoscopic bladder surgery[J].Semin Urol,1992,10(4):213-221.
[5]TAREEN BU,MUFARRIJ PW,GODOY G,et al.Robot-assisted laparoscopic partial cystectomy and diverticulectomy:initial experience of four cases[J].J Endourol,2008,22(7):1497-1500.
[6]Ryan AC,Gamal MG.Transurethral electrovaporization of bladder diverticulum:An alternative to open or laparoscopic bladder diverticulectomy[J].J Endourol,2015,1:11-13.
[7]DIEGO ANTONIO PRECIADO-ESTRELLA,PASCUAL CORTES-RAYGOZA,JORGE GUSTAVO MORALES-MONTOR,et al.Multiple bladder diverticula treated with robotic approachassisted with cystoscopy[J].Urol Annals,2018,10:114-117.
[8]IITER TUFEK,PANAGIOTIS MOURMOURIS,OMER BURAK ARGUN,et al.Robot-assisted bladder diverticulectomy with concurrent management of bladder outlet obstruction[J].Urol Int,2016,96:432-437.
[9]RASSWEILER J,TEBER D,KUNTZ R,et al.Complication of transurethral resection of the prostate(TURP)-incidence,management,and prevention[J].Eur Urol,2006,50:969-979.
[10]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.
[11]章俊,王曦龙,史朝亮,等.1 470nm半导体激光前列腺汽化剜除术治疗复杂性良性前列腺增生(附80例报告)[J].现代泌尿外科杂志,2017,22(3):173-175.
[12]MICHALAK J,TZOU D,FUNK J.HoLEP:the gold standard for the surgical management of BPH in the 21st century[J].Am J Clin Exp Urol,2015,3(1):36-42.