B超引导经会阴局麻下经尿道前列腺双波长激光汽化术的疗效观察

Clinical efficacy of transurethral dual-wavelength laser vaporization of prostate under transperineal local anesthesia guided by B-ultrasound

摘要:

目的 探讨B超引导经会阴局麻下经尿道前列腺双波长激光汽化术的安全性及疗效。方法 回顾性分析2017年12月－2019年6月长沙市第四医院40例高危良性前列腺增生（BPH）患者的临床资料，患者均在B超引导下经会阴途径局部麻醉后应用980/1 470 nm双波长激光行前列腺激光汽化术。统计手术时间、术中疼痛程度、膀胱冲洗时间、留置导尿管时间。比较术前2 h、术中、术后2 h患者生命体征和血红蛋白变化情况、术前、术后1个月、术后6个月的最大尿流率（Qmax）、残余尿量（RUV）和国际前列腺症状评分（I-PSS）。结果 手术时间为（25.6±13.2）min，麻醉效果基本满意。患者术前2 h与术中、术后2 h生命体征和血红蛋白变化情况比较，差异均无统计学意义（P > 0.05）。膀胱冲洗时间为（1.6±0.5）d，留置导尿管时间为（3.3±1.2）d。术后出现尿路感染8例，尿路刺激征7例，均经对症治疗后痊愈；无尿失禁、排尿困难及尿道狭窄等并发症发生，无输血和再手术病例。Qmax由术前的（6.8±2.4）mL/s增加到术后的（20.2±1.4）mL/s，RUV由术前的（158.2±43.2）mL降至术后的（26.5±14.3）mL，术后I-PSS为（6.5±1.7）分，明显低于术前的（26.9±1.4）分，手术前后比较，差异均有统计学意义（P < 0.05）。结论 B超引导经会阴局麻下经尿道前列腺双波长激光汽化术是治疗高危BPH患者的新方法，具有手术时间短、创伤小和恢复快等优点。可避免高危BPH患者因椎管内麻醉或全身麻醉风险而放弃手术。

Abstract:

Objective To explore the safety and efficacy of transurethral dual-wavelength laser vaporization to treat high-risk prostatic hyperplasia under transperineal local anesthesia guided by B-ultrasound.Methods The clinical data of 40 patients with high-risk benign prostatic hyperplasia (BPH) from December 2017 to June 2019 were analyzed retrospectively. The patients were treated with 980/1 470 nm dual-wavelength laser vaporization under transperineal local anesthesia guided by B-ultrasound. The operation time, intraoperative pain grade, bladder irrigation time and indwelling catheter time were calculated. The changes of vital signs and hemoglobin of patients 2 h before operation, during operation and 2 h after operation were compared. Meanwhile Maximum urinary flow rate (Qmax), residual urine volume (RUV) and international prostate symptom score (I-PSS) were compared preoperatively and 1, 6 month after operation.Results The operation time was (25.6 ± 13.2) min, the anesthetic effect of all cases were satisfactorily. There was no statistical difference in comparison of vital signs and hemoglobin changes at 2 hours before operation, during operation and 2 hours after operation (P > 0.05). Bladder irrigation time was (1.6 ± 0.5) d, the time of indwelling catheter was (3.3±1.2) d. Postoperative urinary tract infection occurred in 8 cases, urinary tract irritation occurred in 7 cases, which improved after symptomatic treatment. There were no complications such as urinary incontinence, dysuria and urethral stricture, there were no cases of blood transfusion and reoperation. The Qmax increased from (6.8 ± 2.4) mL/s preoperatively to (20.2 ± 1.4) mL/s postoperatively. The RUV decreased from (158.2 ± 43.2) mL preoperatively to (26.5 ± 14.3) mL postoperatively, the score of I-PSS dropped from (26.9 ± 1.4) preoperatively to (6.5 ± 1.7) postoperatively, which were statistically significant.Conclusion Transurethral dual-wavelength laser vaporization of the prostate under transperineal local anesthesia guided by B-ultrasound is a new method for the treatment of high-risk BPH patients, It has the advantages of short operation time, less trauma and quick recovery. It can prevent high-risk BPH patients from giving up surgery because of the risk of intraspinal anesthesia or general anesthesia.