【摘要】 目的分析经尿道钬激光剜除前列腺(HOLEP)治疗前列腺增生症的临床疗效及并发症的防治。方法硬膜外下使用大功率100 W钬激光和组织粉碎器对150例患有前列腺增生患者施行经尿道前列腺剜除和前列腺组织粉碎。分析手术时间、组织粉碎时间、术中出血量、术后膀胱冲洗时间、导尿管留置时间和住院时间;术后3个月随访比较手术前后患者最大尿流率(Qmax)、生活质量评分(QOL)和国际前列腺症状评分(international prostate symptom score,IPSS)等指标的变化。结果 150例手术均一次成功,手术时间60~120min,平均(80士14)min,组织粉碎时间20~50 min,平均(30±15)min手术获得前列腺组织重量30~80 g,平均(56±12)g(67.8%),术后膀胱损伤3例,继发出血2例,术后改开放手术1例,尿道狭窄3例,尿失禁2例,无水中毒,无闭孔神经反射。术前Qave(9.2-3.8)mL/s,术后Qave(18-30)mL/s,P<0.01。I-PSS评分达优、良、中3组标准达100%。结论前列腺钬激光剜除疗效可靠,速度快,出血少,术后呈TURP通道,且可直达外科包膜,特别适应高危BPH患者、更多还原

【Abstract】 Objective To study the effect of Holmium laser enucleation of the prostate on benign prostatic hypertrophy and it’ s prevention and treatment of complications.Methods Under the epidural anesthesia,by means of urethra,150 patients with benign prostatic hyperplasia were treated by transurethral high-power 100 W Holmium laser and morcellator.Study were made in operating time,average time of tissue morcellation,blood loss,bladder irrigating time,catheterization time and hospital stay,as well as in maximum urinary flow rate(Qmax),quality of life(QoL),international prostate symptom score(IPSS) 3 months after the surgeryk.Results The operation was successful in 150 patients.The average time of enucleation operation was 80± 14(range 60~ 120) min.The average time of tissue morcellation was 30 + 15(range 20-50) min.The average tissue weight of prostate which was enucleated and morcellated was 56+12(range30-80) g(67.8%).There were 3 patients with bladder injury,2 post-operative patients with secondary bleeding,1patient with being changed into opening operation,3 patients with urethrotenosis,and 2 patient with incontionence of urine,without water-poisoning,without leflex of obturator nerve.Qave 9.2~3.8 mL/s(preoperation) and Qave 18 ~ 30 mL/s(postoperation),(P<0.01).Symptomatic scores(I-PSS) exceeded to middle grade in 100%patients.Conclusion The effect of the Holmium laser enucleation of prostate were reliable and safe.The incision was low bleeding with fast.Postopertion shew TURP passage.Holmium laserenucleating prostate can noto the circular fibers of prostate capsule.It was suitable for advanced aged and patients with critical diseases.更多还原