Safety and Efficacy of Transurethral Non-Contact Nd: YAG Laser Treatment of High Risk Patients with Benign Prostatic Hyperplasia

經尿道非接觸式Nd: YAG雷射治療高危險群攝護腺肥大症之安全性與有效性

劉志光(Chih-Kuang Liu) ； 柯明中(Ming-Chung Ko) ； 李文凱(Wen-Kai Lee) ； 江漢聲(Han-Sun Chiang)

《北市醫學雜誌》 1卷1期 (2004/01) Pp. 32-42

https://doi.org/10.6200/TCMJ.2004.1.1.07

摘要

背景：攝護腺肥大症合併排尿障礙症狀是中老年男性常見的疾病，臨床治療有多種選擇，除藥物外，常規經尿道內視鏡切除手術是根本治療的方法，但部分對藥物治療效果不佳又具有高手術風險的病患；如嚴重心血管疾病、腦血管疾病、高血壓、醣尿病以及肝腎功能障礙等，常造成治療上之困擾。方法：自2000年3月至 2002年9月止，我們嘗試使用非接觸式Nd: YAG雷射治療此等病患，並評估其安全性及有效性。研究中收集58位高風險群病患，其中33名進行雷射治療手術，25位進行常規內視鏡切手術；同時另有153位非高風險群攝護腺肥大症病患也進行常規內視鏡切除手術。所有病患都完成主觀症狀調查表（IPSS）、經直腸超音波測量攝護腺體積、攝護腺特異抗原、尿流率以及餘尿量（置管者僅測術後）等；術後6週、3個月、6個月及12個月做追蹤。結果：雷射手術平均手術時間28.7分鐘，術中平均沖洗量為8.2公升，術後無需連續沖洗，導尿管置放時間10.2日，術後2.2日出院。術後六週之主觀症狀與餘尿量進步約130%與90%，相較於常規內視鏡切除手術無顯著差異；而平均最大尿流率由6.3ml／sec進步至10.7 ml／sec，較內視鏡切手術稍差。術中出血需輸血者，在高風險與非高風險群接受常規切除手術者各有12%與7.2%，術中或術後併發心臟與腎臟病變者為8%與6.54%，雷射治療組則無。結論：整體而言；以Nd: YAG雷射治療高危險群攝護腺肥大症之安全性與有效性是可接受的，我們認為較長期追蹤其成效是必要的。

關鍵字

Nd: YAG雷射 ； 攝護腺肥大症 ； 內視鏡切除手術

並列摘要

Objective: To study the safety and efficacy of transurethral non-contact Nd: YAG laser prostatectomy in high surgical risk patients with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Patients and Methods: A randomized controlled study was performed between March 2000 and September 2002. The study included 211 patients with symptomatic BPH divided into three groups. Thirty-three cases with high surgical risk undergoing transurethral non-contact Nd: YAG laser ablation of the prostate, 25 cases with high surgical risk and another 153 low risk cases were treated with conventional TURP. Over a 30 month period, all patients with bladder outlet obstruction due to BPH were evaluated by lnternational Prostate Symptom Score (IPSS), urinary flow rate, prostate volume and post-void residual volume. Patients with carcinoma of the prostate, elevated levels of prostate specific antigen and chronic urinary retention were excluded. Each patient was followed for up to 12 months after the procedure. Results: Symptom scores improved by 130% and residual volume by 90% in non-retention patients, the mean peak flow rate increased from an average of 6.3 mL／s before treatment to 10.7 mL／s at the six week follow-up in the Nd: YAG laser treatment group. The procedure was safe and simple, mean operation duration was 28.7 minutes, and no patient required a blood transfusion. Most patients had their catheters removed successfully on 10th day after the procedure. Conclusion: This study has demonstrated that Nd: YAG laser ablation was safe and effective in improving symptoms and other urologic parameters in high surgical risk BPH patients, had minimal adverse effects and maintained quality of life. It appeared to have several advantages over other surgical treatments for BPH, but further study is needed to determine the long-term results.

並列關鍵字

benign prostatic hyperplasia (BPH) ； Nd: YAG laser ； transurethral resection of prostate (TURP)