高功率绿激光前列腺气化切除术治疗前列腺癌所致下尿路梗阻

Greenlight laser high performance system for photoselective vaporization of prostate in treatment of lower urinary tract obstruction in prostate cancer

摘要:

目的 探讨140W高功率绿激光前列腺气化切除术治疗前列腺癌（PCa）所致下尿路梗阻的安全有效性。方法 选取2009年8月至2012年2月于我院行高功率绿激光前列腺气化切除术的晚期或高龄、高危PCa所致下尿路梗阻患者65例，对手术时间、术中出血量、术后留置导尿时间、并发症、最大尿流率、国际前列腺症状评分（IPSS）和前列腺体积变化等指标进行评价。结果 65例手术均顺利完成，手术时间50～110（68.9±23.9）min；术中出血量50～140（74.9±22.4）ml；住院时间5～7d，无永久性尿失禁，术后1个月最大尿流率由（4.98±2.15）ml/s提高到（15.31±3.36）ml/s，前列腺体积由（72.3±13.9）g减至（35.4±6.8）g，IPSS评分由术前平均（22.15±3.41）减少到（6.02±2.01），手术前后差异均有统计学意义（P＜0.01）。结论 高功率绿激光手术，因其具有出血少、术后恢复快、并发症少等优点，是PCa所致下尿路梗阻治疗手术方式的一个较好选择。

Abstract:

Objective To evaluate the efficacy and safety of 140W greenlight laser high performance system (HPS) for photoselective vaporization of prostate (PVP) procedure in the treatment of lower urinary tract obstruction secondary to prostate cancer. Methods A total of 65 senile prostate cancer patients suffering from lower urinary tract obstruction who were admitted in our department and treated with greenlight laser HPS from August 2009 to February 2012 were enrolled in this study. Their operation manipulation time, peri-operative bleeding, post-operative catheterization time, complications, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and the change in prostate volume before and after treatment were recorded. Results All procedures were completed successfully in the cohort. The operation time ranged from 50 to 110 (68.9±23.9)min, the peri-operative bleeding amount from 50 to 140 (74.9±22.4)ml, and hospitalization time from 5 to 7d. No permanent urinary incontinence was found. Qmax was increased from (4.98±2.15)ml/s to (15.31±3.36)ml/s at 1 month after operation, the volume of the prostate was decreased from (72.3±13.9)g to (35.4±6.8)g, and the IPSS score was decreased from (22.15±3.41) to (6.02±2.01). Significant difference was found in all above indices before and after surgery (P＜0.01). Conclusion Greenlight laser HPS PVP procedure is a better approach for lower urinary tract obstruction secondary to prostate cancer because of its small amount of blood loss, rapid postoperative recovery and lower incidence of complications.