组织粉碎器在1.94μm 铥激光剜除术治疗体积大于80 ml 前列腺增生的应用研究

Application of morcellator in 1.94 μm thulium laser enucleation of benign prostatic hyperplasia with volume >80 ml

摘要:

目的 探讨组织粉碎器在1.94μm 铥激光剜除体积大于80 ml 前列腺增生（BPH）术中的应用及 效果。方法 对2014 年9 月-2016 年6 月该院收治的95 例体积>80 ml 的良性BPH 患者根据剜除后组织取 出方法分两组进行对照试验：A 组45 例，采用1.94μm 铥激光剜除后汽化切割成碎块冲出；B 组50 例，采用 1.94μm 铥激光剜除后粉碎器吸出。观察两组的手术时间、术后第1 天血红蛋白下降值、住院时间、获取的 腺体组织重量、尿管留置时间、近期并发症发生率和术后3 个月的前列腺症状评分（IPSS）、残余尿量（PVR）、 最大尿流率（Qmax）和生活质量评分（QOL）。结果 两组在手术时间、获取的腺体组织重量差异有统计学意义， B 组手术时间明显低于A 组（P <0.05），获取的腺体组织重量明显多于A 组（P <0.05）。两组在血红蛋白下 降量、住院时间、留置尿管时间和近期并发症差异无统计学意义（P >0.05）。术后3 个月复查IPSS、PVR、 Qmax 和QOL，两组均比术前有显著改善（P <0.05），两组间术后IPSS、PVR、Qmax 和QOL 比较差异无统计学 意义（P >0.05）。结论 1.94μm 铥激光前列腺剜除术后无论是采取激光汽化切割组织还是用粉碎器吸出组织， 均具有安全性高、疗效好和并发症低等特点。但采取粉碎器吸出组织具有能缩短手术时间、获取更多的组织 标本等优势。

Abstract:

Objective To investigate the effect of 1.94 μm thulium laser enucleation of benign prostatic hyperplasia (BPH) with volume >80 ml by morcellator. Methods From September 2014 to June 2016, there were 95 BPH patients with prostate volume over 80 ml treated by thulium laser were divided into two groups according to the surgical procedure: 45 cases in group A, prostate tissue were washed out of bladder after vapoenucleation by 1.94 μm thulium laser; 50 cases in group B, the enucleated prostate tissue were extracted by morcellator. The operation time, the decreasing level of hemoglobin on the first day after surgery, the hospitalization time, the gland tissue weight, catheterization duration, short-term incidence of complications, and the IPSS, PVP, Qmax, QOL in 3 months after surgeon of the two groups were observed and recorded. Results There was significant difference in operation time and gland tissue weight between the two groups. The group B have significantly short operation time compared with group A (P < 0.05), and obtained gland tissue remarkably exceed the group A (P < 0.05). No significant differencewas found in hemoglobin level, hospitalization time, catheterization duration, and short-term complication between the two groups (P > 0.05). The IPSS, PVR, Qmax and QOL of 3 month, after operation were significantly improved but without any significant difference between the two groups (P < 0.05). Conclusion Vaporization cutting tissue or morcellating tissue after 1.94 μm thulium laser enucleation has high safety, good curative effect and low complication, while extraction prostate tissue by morcellator can shorten the operation time and get more tissues.