钬激光同期治疗良性前列腺增生合并输尿管结石的疗效观察
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摘要
目的探讨同期使用钬激光微创技术治疗良性前列腺增生(Benign Prostatic Hyperplasia,BPH)合并输尿管结石病人的安全性和疗效。方法回顾性分析华北理工大学附属医院泌尿外科2015年4月～2018年4月BPH合并输尿管结石病人60例。利用钬激光微创技术同期对BPH合并输尿管结石病人进行治疗。结果 60例BPH合并输尿管结石病人的手术全部顺利完成,手术所使用的时间平均为75.4±16.7min,术中无明显活动性出血,并无输血、无输尿管穿孔及中转开放手术的病例。手术后患者所携带导尿管的时间平均为2.5±0.4 d,手术1～3个月后患者的国际前列腺症状评分(International Prostate Symptom Score,IPSS)较术前减少56.5%(P<0.01),最大尿流率(Qmax)和术前相比增加155.4%(P<0.01),手术后膀胱内残余尿量(Postvoid Resid,PVR)与术前相比减少了77.5%(P<0.01),术后病人未出现尿失禁及明显的膀胱刺激征,术后均保留性功能,术后拔除DJ管后复查卧位腹平片(KUB)无结石残留。结论同期使用钬激光微创手术方式医治BPH合并输尿管结石的患者,是安全有效的。
Objective To explore the efficacy and safety of the Holmium Laser Treatment for Benign Prostatic Hyperplasia and Ureteal Caculi. Methods Data of 60 patients who underwent the Holmium Laser Treatment for Benign Prostatic Hyperplasia and Ureteal Caculi in our department between Apirl 2015 and Apirl 2018. Results The 60 cases were safe during the perioperative period and no serve complications occured. The average operation time was(75.4±16.7)min, the blood loss is minimum. The time of remove the transurethral catheter is 2～5 days,mean time(2.5±0.4) d. A significant reduction in IPPS was reported at 1 month(P<0.01) and this was maintained through to 3 months. Significant durable improvements in Qmax, PVR and IPSS were also reported for all patients(P<0.01).No severe complications were reported, including any cases of urinary incontinence or significant irritative symptoms. None of the patients complained of a worsening of erectile function. No residual were seen two months after the operation by ultrosoundgraphy. Conclusion Holmium Laser Treatment for Benign Prostatic Hyperplasia and Ureteal Caculi is both effective and safe.
Objective To explore the efficacy and safety of the Holmium Laser Treatment for Benign Prostatic Hyperplasia and Ureteal Caculi. Methods Data of 60 patients who underwent the Holmium Laser Treatment for Benign Prostatic Hyperplasia and Ureteal Caculi in our department between Apirl 2015 and Apirl 2018. Results The 60 cases were safe during the perioperative period and no serve complications occured. The average operation time was(75.4±16.7)min, the blood loss is minimum. The time of remove the transurethral catheter is 2～5 days,mean time(2.5±0.4) d. A significant reduction in IPPS was reported at 1 month(P<0.01) and this was maintained through to 3 months. Significant durable improvements in Qmax, PVR and IPSS were also reported for all patients(P<0.01).No severe complications were reported, including any cases of urinary incontinence or significant irritative symptoms. None of the patients complained of a worsening of erectile function. No residual were seen two months after the operation by ultrosoundgraphy. Conclusion Holmium Laser Treatment for Benign Prostatic Hyperplasia and Ureteal Caculi is both effective and safe.
引文
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[9]比较尿道前列腺剜除术与电切术治疗前列腺增生的临床疗效分析[J].国际泌尿系统杂志,2015,(4).
[10]两种手术方式治疗前列腺增生的有效性和安全性研究[D].新疆医科大学,2015.
[11]GILLING P J,KENNETT K,.,DAS A K,et al.Holmium laser enucleation of the prostate(HoLEP)combined with transurethral tissue morcellation:an update on the early clinical experience[J].Journal of Endourology,1998,12(5):457-459.
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[13]刘健,康绍叁,张小军,等.980nm半导体红激光汽化术在良性前列腺增生治疗中的应用[J].中华男科学杂志,2013,19(5):422-424.
[14]任利生.经尿道前列腺汽化电切术与经尿道前列腺电切术治疗前列腺增生的临床疗效比较[J].中国实用医刊,2017,44(4):107-109.
[2]白剑锋.经尿道前列腺电切术(TURP)对68例良性前列腺增生(BPH)患者的治疗效果[J].医疗装备,2015,(12):81-82.
[3]刘修恒.绿激光在治疗前列腺增生症中的应用[J].临床外科杂志,2013,21(11):830-831.
[4]杨玉春.经尿道钬激光碎石术联合等离子电切术治疗前列腺增生合并膀胱结石[J].世界最新医学信息文摘,2016,16(87):23.
[5]吴在德,吴肇汉.外科学[M].7版.北京:人民卫生出版社,2008:132.
[6]方友强,湛海伦,吴杰英.膨宫机在输尿管镜手术处理输尿管结石合并息肉的应用价值[J].中华腔镜泌尿外科杂志(电子版),2012,06(3):36-40.
[7]CAUNI V,MITROI V,CHUAIBI A,et al.C125 Initial experience with semirigid ureteroscopy and Holmium laser lithotripsy for ureteral calculi[J].European Urology Supplements,2013,12(4):e1233,C1125.
[8]陈静辉.输尿管镜下钬激光碎石术治疗尿道结石的临床观察[J].中国现代医生,2016,54(36):52-55.
[9]比较尿道前列腺剜除术与电切术治疗前列腺增生的临床疗效分析[J].国际泌尿系统杂志,2015,(4).
[10]两种手术方式治疗前列腺增生的有效性和安全性研究[D].新疆医科大学,2015.
[11]GILLING P J,KENNETT K,.,DAS A K,et al.Holmium laser enucleation of the prostate(HoLEP)combined with transurethral tissue morcellation:an update on the early clinical experience[J].Journal of Endourology,1998,12(5):457-459.
[12]GILLING P J,CASS C B,CRESSWELL M D,et al.Holmium laser resection of the prostate:preliminary results of a new method for the treatment of benign prostatic hyperplasia[J].Urology,1996,47(1):48-51.
[13]刘健,康绍叁,张小军,等.980nm半导体红激光汽化术在良性前列腺增生治疗中的应用[J].中华男科学杂志,2013,19(5):422-424.
[14]任利生.经尿道前列腺汽化电切术与经尿道前列腺电切术治疗前列腺增生的临床疗效比较[J].中国实用医刊,2017,44(4):107-109.