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目的探讨微拉(Vela XL)激光手术治疗良性前列腺增生症(BPH)的方法和临床效果,并评估其安全性。方法 2013年7月-2014年4月,应用经尿道微拉激光手术治疗80例BPH。患者平均年龄(73.3±10.6)岁,前列腺术前体积平均(75.8±23.5)ml,术前IPSS评分(21.3±9.1)分,最大尿流率(Qmax)(6.9±3.8)ml/s。手术方法采用分叶整体切割法:先在5、7及12点处分别切开一沟槽,内至膀胱颈,外不超过精阜,宽约0.5~1.0cm,深达外科包膜,然后从12点处开始,贴近包膜整体切除左侧叶,当还有少量组织未完全离断时,用激光将左侧叶快速汽化切割成小块组织以便能冲出,同法切除右侧叶,最后切除中叶。结果手术时间平均(50.1±18.3)min,术中无明显出血,无手术并发症,无输血病例。术后导尿管留置时间平均2.6(1~3)d。术后1个月IPSS评分(6.9±2.5)分,Qmax(23.8±5.1)ml/s,与术前相比均有显著改善(P<0.05)。结论微拉激光具备强大的汽化切割功能和良好的止血功能,对组织的热损伤小。分叶整体切割法适用于微拉激光前列腺切除,具有切除速度快、组织切除彻底、并发症少及安全性高等优点。
Objective To investigate the method and clinical efficacy of Vela XL laser in the treatment of benign prostatic hyperplasia (BPH) and evaluate its safety. Methods From July 2013 to April 2014, 80 cases of BPH were treated by urethral micro-laser surgery. The average age of the patients was 73.3 ± 10.6 years. The average preoperative prostate volume was 75.8 ± 23.5 ml. The preoperative IPSS score was 21.3 ± 9.1 and the maximum flow rate was 6.9 ± 3.8 ml / s. Surgical methods using lobectomy method: first at 5,7 and 12 points were cut a trench, within the bladder neck, no more than fine Fu, a width of 0.5 ~ 1.0cm, deep surgical wrapping, and then From 12 o’clock at the beginning, close to the overall removal of the left envelope leaves, when there is still a small amount of tissue is not completely broken, the left side of the leaves with a laser rapid vaporization cut into small pieces of tissue can be washed out, , The final removal of the middle. Results The average operation time was (50.1 ± 18.3) min, no obvious intraoperative bleeding, no complications and no blood transfusion cases. Postoperative catheter indwelling time average 2.6 (1 ~ 3) d. The IPSS score (6.9 ± 2.5) and Qmax (23.8 ± 5.1) ml / s at 1 month after operation were significantly improved compared with those before operation (P <0.05). Conclusion Microlaser laser with a strong vaporization and cutting function and good hemostatic function, thermal damage to the tissue is small. Partial leaf cutting method for micro-laser laser prostatectomy, with resection speed, complete tissue resection, fewer complications and high safety advantages.