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目的探讨绿激光治疗高风险(大体积或高龄、高危)前列腺增生患者的疗效和安全性。方法回顾性分析2003年10月至2013年5月,大体积、高龄、高危前列腺增生患者425例,采用经尿道绿激光前列腺汽化术(photoselective vaporization of prostate,PVP)术治疗。观察手术时间,手术前后国际前列腺症状评分表(International-prostatic symptom score,IPSS)评分,最大尿流率(maximum flow rate,Qmax)等指标的变化,术中、术后并发症,术后留置尿管时间,术后在院时间等指标。结果 425例患者中343例一次完成手术,82例分两次完成手术。手术时间为(131.6±57.7)min,术后留置尿管时间及术后住院时间分别为(3.6±1.6)d和(4.9±1.7)d。术后1 d与术前血红蛋白浓度分别为(11.5±1.4)g/dl、(11.3±1.7)g/dl,血钠浓度分别为(136.8±4.1)mmol/l、(137.1±2.5)mmol/l,与术前比较差异无显著意义(P>0.05)。28例患者在拔除尿管48h内出现一过性急迫性尿失禁,23例在术后1个月内出现轻微继发性出血,1例患者术后48 h内出现2次心跳骤停,经全力抢救后顺利出院。术后1个月复查Qmax为(14.6±2.4)ml/s,IPSS评分为(5.7±3.4)分,与术前相比均有明显改善(P<0.01)。结论绿激光治疗大体积、高龄、高危前列腺增生患者安全有效,其适用范围更广,值得推广。
Objective To investigate the efficacy and safety of green laser in the treatment of high-risk (large-volume or advanced-age, high-risk) BPH patients. Methods From October 2003 to May 2013, 425 patients with large-volume, elderly and high-risk benign prostatic hyperplasia were retrospectively analyzed. They were treated by photoselective vaporization of prostate (PVP). The changes of operation time, international-prostatic symptom score (IPSS) score and maximum flow rate (Qmax) were observed before and after surgery. The intraoperative and postoperative complications, postoperative indwelling urine Tube time, postoperative hospital time and other indicators. RESULTS: Of the 425 patients, 343 completed the operation at one time and 82 completed the operation in two. The operative time was (131.6 ± 57.7) min. The duration of postoperative catheterization and postoperative hospital stay were (3.6 ± 1.6) days and (4.9 ± 1.7) days, respectively. The levels of hemoglobin on day 1 postoperatively and preoperatively were (11.5 ± 1.4) g / dl and (11.3 ± 1.7) g / dl respectively, and the serum sodium concentrations were (136.8 ± 4.1) mmol / l and (137.1 ± 2.5) mmol / l, compared with the preoperative difference was not significant (P> 0.05). Twenty-eight patients had transient urge incontinence 48 hours after catheter removal, 23 cases had mild secondary hemorrhage within one month after operation, and one patient had two cardiac arrest within 48 hours after operation. After full rescue, the patients were discharged smoothly. Qmax was (14.6 ± 2.4) ml / s and IPSS score was (5.7 ± 3.4) at 1 month postoperatively, which were significantly improved compared with that before operation (P <0.01). Conclusion Green laser treatment is safe and effective for patients with large volume, advanced age and high risk of benign prostatic hyperplasia, and its application is more extensive and worthy of promotion.