銩雷射對台灣攝護腺肥大病人的手術成效研究

The study of Thulium Laser surgery for Taiwanese Patients with Benign Prostate Hyperplasia

張譯丰(Yi-Feng Chang)

指導教授 ： 謝瑞香 ； 王炯珵

中原大學/工學院/生物醫學工程研究所/碩士(2014年)

https://doi.org/10.6840/cycu201400508

摘要

銩雷射攝護腺汽化摘除 (Thulium vapoenucleation of the prostate, ThuVEP) 藉由低侵入性的方式治療良性攝護腺阻塞 (benign prostatic obstruction, BPO)。然而手術後引起之併發症，目前臨床上仍缺乏標準化的紀錄方式。因此本研究藉由回溯性研究方法 (Retrospective study)，探討 2007 年 11 月至 2013 年 9 月期間，於恩主公醫院經 ThuVEP 治療 BPO 症狀之 41 位病患的手術成效分析。我們依照手術前 (Preoperative)、手術期間 (Perioperative)、術後 (Postoperative) 三個月以內 (Short term)，以及術後三個月 (Long term) 以上等不同時間點，評估銩雷射手術對 BPH 的治療結果和安全性。手術安全性的評估藉由 Clavien 併發症分類系統 (Modified Clavien classification system)，以系統化的方式評估銩雷射對病患造成之影響。統計數據呈現方式使用中位數 (四分位數) 作為表示法。病患年齡為69 (63-74) 歲，攝護腺大小為50.6 (44.1-81) mL，組織切除重量為6 (3.5 - 8.5) g，導尿管留置時間 45 (40.5 -56.5) 小時、住院時間 48 (48 - 72) 小時，經三個月以上的 Long term 術後追蹤，國際攝護腺症狀 (IPSS) 評比分數自24減少為5，生活品質量表 (QoL) 分數自5改善為2，最大尿流速 (Qmax) 自9.7增加為15.7 (mL/s)，排尿後餘尿 (PVR) 自72.1減少為29 (mL)，攝護腺特異抗原 (PSA) 自5.4下降為2.1 (ng/mL)；Short term期間為併發症的好發時期，輕微併發症的事件數佔病患總人數的 107.3% (Clavien 1 : 100%; Clavien 2 : 7.3%)，嚴重併發症為31.8% (Clavien 3a : 22%; Clavien 3b : 9.8%)，不過多數症狀會隨時間的推移而日趨改善。銩雷射為安全且低併發症的 BPO 治療手術，手術過程不需摘除較多組織，其治療成效仍可讓病患感到滿意，病患亦可提早出院。Clavien 併發症分類系統適用於小型醫療機構或樣本數較少的研究，可清楚呈現併發症之間的關聯性，有助於追蹤病情的演變。

關鍵字

發病率 ； Clavien 併發症分類系統 ； 攝護腺肥大 ； 銩雷射攝護腺汽化摘除 ； 銩雅鉻雷射

並列摘要

Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a minimally invasive treatment for benign prostatic obstruction (BPO).However, there is a lack of standardized reporting of the complication rates. The aim of the study is to investigate the therapeutic outcome and safety of thulium laser prostatectomy in patients with benign prostate hyperplasia (BPH). A retrospective evaluation of 41 patients undergoing ThuVEP from May 2007 until September 2013 at En Chu Kong Hospital. The safety was evaluated by modified Clavien classification system. All these evaluation were performed before operation, within 3 months (Short term), over 3 months (Long term) postoperatively. Patient data were expressed as median (interquartile range, IQR). Patient age was 69 (63-74) years, and the prostate volume was 50.6 (44.1-81) mL. Resected tissue weight was 6 (3.5 - 8.5) g. Catheterization time was 45 (40.5 -56.5) hr, and length of hospital stay was 48 (48 - 72) hr. Long term follow-up, international prostate symptom score (24 vs. 5), quality of life (5 vs. 2), maximum urinary flow rate (9.7 vs. 15.7 mL/s), post-voided residual urine (72.1 vs. 29 mL), and prostate-specific antigen (5.4 vs. 2.1 ng/mL); Minor complication usually occurred 3 months postoperatively. Minor complications occurred in 107.3% of the patients (Clavien 1 : 100%; Clavien 2 : 7.3%). Reinterventions were necessary in 31.8% of the patients (Clavien 3a : 22%; Clavien 3b : 9.8%).The overall complication rates decreased significantly over time due to decreasing Clavien 1, 2, 3a, and 3b events. ThuVEP is a safe and effective procedure for the treatment of symptomatic BPO, with low morbidity. In this study, the immediate improvement of obstructive voiding after ThuVEP proved to be satisfactory, and no need to resect too much of tissue. Then, patient can discharge early. Modified Clavien classification system is suitable for small medical institutions and some experiments with relatively smaller amount of sample. It can clearly indicate the relation between complications, thus helping track the progression of the symptom.

並列關鍵字

morbidity ； Thulium : yttrium-aluminum-garnet ； modified Clavien classification system ； Thulium vapoenucleation of the prostate ； benign prostatic hyperplasia

參考文獻

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