CAJ | 학술논문

目的探讨经尿道2μm激光汽化切除术治疗良性前列腺增生症(BPH)的安全性和有效性.方法 2006年10月至2007年9月间应用70 W 2μm激光治疗BPH患者236例,排除有前列腺或尿道手术病史,合并神经源性膀胱功能障碍以及手术后被证实为前列腺癌者,210例纳入本组研究.手术采用经典的U形分块切除或“分割式”切除方法.记录患者基本情况及手术操作时间、收获的前列腺组织质量、输血率,术后留置尿管时间、住院时间,手术前后最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(QoL)及残余尿量(PVR)的变化.术后随访时间为5年.结果本组共179例患者获得5年随访.全部手术均在硬膜外或全身麻醉下完成.平均手术时间为(80±22)min(42 ～ 146 min),平均收获腺体组织质量为(24.9±4.2)g(15.3～32.6g).被切除的前列腺组织块可通过切除镜鞘顺利吸出.全部患者手术前后血钠浓度及血红蛋白水平均无明显变化.3例患者拔除尿管后因残留的已经被切除的前列腺组织块阻塞而发生急性尿潴留,经再次激光汽化切除并置管引流处理于1周后恢复.术后平均留置尿管时间及平均住院时间分别为(114±35)h、(5.7±1.9)d.术后继发出血并输血治疗1例.至随访结束,患者平均Qmax由术前的(8.6±3.5)ml/s增加至(23.6±4.2)ml/s(P ＜0.01),IPSS及QoL评分由术前的25.3 ±5.2、4.1±1.3恢复至6.1±3.0、1.4±0.8(P＜0.01),PVR由术前的(248±89)ml降至(15±13)ml.3例患者术后继发尿失禁,经功能锻炼及针灸治疗3个月后康复.5例患者继发尿道狭窄,分别接受尿道扩张(3例)或尿道内切开(2例)治疗.结论 2μm激光能够安全、有效地汽化切除良性增生的前列腺腺体,术后3个月起患者的排尿困难显著改善,能够在为期5年的长期随访中表现出持久而稳定的疗效.
목적 탐토경뇨도2μm격광기화절제술치료량성전렬선증생증(BPH)적안전성화유효성.방법 2006년10월지2007년9월간응용70 W 2μm격광치료BPH환자236례,배제유전렬선혹뇨도수술병사,합병신경원성방광공능장애이급수술후피증실위전렬선암자,210례납입본조연구.수술채용경전적U형분괴절제혹“분할식”절제방법.기록환자기본정황급수술조작시간、수획적전렬선조직질량、수혈솔,술후류치뇨관시간、주원시간,수술전후최대뇨류솔(Qmax)、국제전렬선증상평분(IPSS)、생활질량평분(QoL)급잔여뇨량(PVR)적변화.술후수방시간위5년.결과 본조공179례환자획득5년수방.전부수술균재경막외혹전신마취하완성.평균수술시간위(80±22)min(42 ～ 146 min),평균수획선체조직질량위(24.9±4.2)g(15.3～32.6g).피절제적전렬선조직괴가통과절제경초순리흡출.전부환자수술전후혈납농도급혈홍단백수평균무명현변화.3례환자발제뇨관후인잔류적이경피절제적전렬선조직괴조새이발생급성뇨저류,경재차격광기화절제병치관인류처리우1주후회복.술후평균류치뇨관시간급평균주원시간분별위(114±35)h、(5.7±1.9)d.술후계발출혈병수혈치료1례.지수방결속,환자평균Qmax유술전적(8.6±3.5)ml/s증가지(23.6±4.2)ml/s(P ＜0.01),IPSS급QoL평분유술전적25.3 ±5.2、4.1±1.3회복지6.1±3.0、1.4±0.8(P＜0.01),PVR유술전적(248±89)ml강지(15±13)ml.3례환자술후계발뇨실금,경공능단련급침구치료3개월후강복.5례환자계발뇨도협착,분별접수뇨도확장(3례)혹뇨도내절개(2례)치료.결론 2μm격광능구안전、유효지기화절제량성증생적전렬선선체,술후3개월기환자적배뇨곤난현저개선,능구재위기5년적장기수방중표현출지구이은정적료효.
Objective To summarize the 5-year follow-up to 2 micron continuous wave laser vaporesection for the treatment of patients with low urinary tract symptoms(LUTS)secondary to benign prostatic hyperplasia(BPH),and evaluate the safety and clinical effects of the treatment.Methods From October 2006 to September 2007,236 cases with low urinary tract symptom secondary to BPH were treated transurethrally under epidural or general anesthesia using the 70 Watt 2 micron laser system.Vaporesection of the prostate was performed with the traditional "U" or the "dividing" method.The 210 cases who met the inclusion criteria in this study were selected for further observation.Baseline and perioperative data were recorded and evaluated in resection time,transfusion rate,catheter-time,improvements in maximal urinary flow rate(Qmax),international prostate symptom scores(IPSS),quality of life(QoL),and post voiding residual volume(PVR).Results Out of the 210 cases,179 cases were followed up to 5 years finally.All the surgical procedures were successfully conducted under epidural or general anesthesia.Mean operation time was(80 ± 22)minutes,and mean retrieved prostatic tissue was(24.9 ± 4.2)g.Resected prostatic tissues could be easily flashed out of the bladder.There were no significant differences in serum sodium concentrations and hemoglobin levels before and after the surgery.Mean catheter time and hospital stay was (114 ± 35)hours and(5.7 ± 1.9)days respectively.Only one postoperative secondary hemorrhage was found and treated with blood transfusion.During the 5-year follow-up,Qmax increased from(8.6 ± 3.5)ml/s preoperatively to(23.6 ± 4.2)ml/s by the end of the follow-up(P ＜ 0.01),IPSS and QoL-Score improved from 25.3 ± 5.2 and 4.1 ± 1.3 to 6.1 ± 3.0 and 1.4 ± 0.8 respectively(P ＜ 0.01),and PVR decreased from(248 ± 89)ml to(15 ± 13)ml.The 3 patients developed urinary incontinence and recovered 3 months later through functional exercises with the help of acupuncture.Five patients were found to have urethral stricture 3 months after the surgery and recovered with the treatment of urethral dilatation(3 cases)or internal urethrotomy(2 cases)respectively.Conclusions Transurethral vaporesection of prostate using the 2 micron continuous wave laser system is a safe and effective treatment for benign prostatic hyperplasia with obvious improvements in subjective and objective voiding parameters,which were evident at 3 months after the surgery and were sustained throughout the 5-year long-term follow-up.