- 期刊
Holmium Laser Ablation of Prostate for Benign Prostate Hyperplasia
鈥釔雷射攝護腺汽化術治療攝護腺肥大
摘要
目的：對於攝護腺肥大合併有排尿症狀者，經尿道攝護腺刮除術(TURP)仍是標準治療。近來針對攝護腺肥大有發展出數種微小侵犯性治療，例如鈥釔雷射攝護腺氣化術(HoLAP)。我們報告關於此術式的早期成果。方法：自2005年九到十二月間，有20位年紀在病患55到84歲（平均70.8歲）的病患接受此術式。所採用的雷射機器為Trimedyne公司的OmniPulse(上標 TM) MAX 80 Watt Holmium Laser。在術前的評估包括了攝護腺特異抗原指數(PSA)、國際攝護腺症狀分數(IPSS)、尿流速、膀胱餘尿量（以bladder scan評估）、攝護腺體積（以經直腸超音波評估）以及國際勃起功能指標（IIEF-15和-5）。手術方面則紀錄有手術時間、導尿管置放期間以及術後立即併發症。病患在手術後一個月以及每三個月接受再追蹤。結果：平均PSA值為2.83±2.13(0.56~6.29)ng/dl；至於術前平均IPSS總分、阻塞以及刺激分數分別為20.7±7.6(4~33)、11.7±5.7(0~20)和9.0±3.7(2~14)。最大尿流速為11.9±2.4(9.8~15)毫升每秒，餘尿量38.8±31.7(12~95)毫升，而攝護腺體積為50.4±41.8(23~123)毫升。手術平均時間為30±41.8(15~80)分，導尿管置放期間為28.3±14.0(6~50)小時，平均住院天數為3天。有3位病患(15%)在提早拔除導尿管發生尿滯留而必須重新裝上導尿管。在術後一個月的IPSS總分為11.2±6.3(2~20)，阻塞分數為3.5±3.2(1~6)，最大尿流速為25.0±2.0(19~30)毫升每秒。勃起功能方面，術前的IIEF-15以及-5分數分別是33.5±23.1(5~63)和12.7±10.3(2~14)，而術後一個月的分數分別是30.3±27.9(5~55)和10.0±9.9(2~13)。勃起功能上並沒有明顯差異。結論：儘管HoLAP減低TURP可能的風險，並且大部分病患在排尿方面獲得改善，仍有部分病患在提早拔除導尿管發生尿滯留。為了了解HoLAP的利弊，更長期的追蹤有其必要。
並列摘要
Background and Purpose: Transurethra resection of prostate (TURP) remains the gold standard treatment for benign prostate hyperplasia (BPH). Recently, several minimally invasive therapies for BPH were developed, such as holmium laser ablation of prostate (HoLAP). We report our preliminary results of HoLAP for BPH. Methods: From Sep. to Dec. 2005, we used OmniPulse(superscript TM) MAX 80 Watt Holmium Laser (Trimedyne®)for 20 patients, age 58 to 84 years old (mean 70.8±8.1), with BPH. Pre-operative prostate specific antigen (PSA), international prostate symptom score (IPSS), uroflow rate, residual urine (assessed by bladder scan), prostate size (assessed by transrectal ultrasound) and international index of erectile function (IIEF-15 and -5) were surveyed. The operation time, Foley catheter indwellation period and immediate post-operative complications were documented. The patients received post-operative survey one month later and every 3 months. Results: The level of PSA was 2.83 ng/dl. The pre-operative mean total IPSS, obstructive and irritative scores were 20.7, 11.7 and 9.0, respectively. Maximum flow rate was 11.9 ml/sec, residual urine 38.8 ml, and prostate size 50.4 ml. The operation time was 30 minutes, Foley indwellation period 28.3 hours, and mean hospital stay 3.0 days. Three patients suffered from urine retention after removal of Foley catheter and needed re-indwellation. The IPSS in one month after surgery was 11.2, obstructive scores were 3.5, and uroflow rate was 25.0 ml/sec. The pre-operative and one month after surgery IIEF-15 and -5 scores were 33.5, 12.7, and 30.3, 10.0, respectively. No significant difference on erectile function was noted after surgery. Conclusion: Though HoLAP reduced surgical risk as TURP, and most patients got benefit from it, 15% patients still suffered from urine retention after early removal of Foley catheter. Longer post-operative survey is necessary to evaluate the true outcome of HoLAP.