併用Nd:YAG接觸性雷射切開法與非接觸性凝固壞死法治療前列腺肥大——初報

Combined Use of Nd:YAG Contact Laser Incision and Non-Contact Coagulation Necrosis in the Treatment of Benign Prostatic Hypertrophy-A Preliminary Report

報告我們綜合Nd:YAG接觸性雷射切開法與Nd:YAG非接觸性雷射凝固壞死法運用於治療前列腺肥大的經驗。本改良法可以使得病人能夠迅速改善排尿狀態，同時又能保持前行性射精。自1998年11月至1999年3月間，共有31例病人具有明顯前列腺阻塞症狀，且前列腺的體積小於30ml，接受改良式Nd:YAG雷射前列腺切除術。首先使用Nd:YAG接觸性雷射以類似Orandi氏前列腺切開術的方式作高溫氣化式切開，此切開處需氣化成3〜5mm寬的壕溝。再輔以Nd:YAG非接觸性雷射側光照射，以增加剝除前列腺的體積。精阜近端0.5〜1.0公分的前列腺組織則予以保留，不作切開或側光照射的處理。留置導尿管於術後第一日中午拔除，病人若解尿順暢則於術後第二日出院。手術前後各項數據的比較，以Wilcoxon signed ranks test作統計學的分析。31例病人平均年齡為63.3歲，平均前列腺體積為18.2ml。手術前與手術後6個月之各項數據平均值比較如下：國際前列腺症狀評分表24.0分對7.31分（p<0.01）；最大尿流速8.13 ml/s對14.5 ml/s（p<0.01）；殘尿量5l.9ml對33.6ml（p=0.144）。手術時間平均為53分鐘。術後24小時內有29人（93.5%）可以恢復自行解尿，且最大尿流速平均達到12.3 ml/s。有16人嘗試性生活，其中15人（93.8%）報告仍保有前行性射精。術後無水中毒或大量出血等現象。改良式Nd:YAG雷射前列腺切除術是一安全而有效的前列腺肥大替代性療法。此法可以使90%以上病人於24小時恢復解尿功能，最大尿流速在術後24小時可以增加50%，且維持6個月以上。此改良法之另一項好處是能維持94%病人之前行性射精。

To report on the combined use of Nd:YAG contact laser incision and Nd:YAG non-contact coagulation necrosis in the treatment of benign prostatic hypertrophy (BPH). This modification has the advantage of providing early improvement of voiding function and preservation of antegrade ejaculation. Between November 1998 and March 1999, 31 patients with voiding dysfunction secondary to BPH, with a prostatic size less than 30 ml, were enrolled in this study. Nd:YAG contact laser was used to incise the prostate with the technique of Orandi's transurethral incision of prostate. The incision line was vaporized to a 3-5mm trough. The prostatic adenoma was then coagulated by the free beam of the Nd:YAG laser in order to increase volume reduction. The prostatic tissue 0.5 to 1.0 cm proximal to the verumontanum was preserved during the procedure. A Foley catheter was removed at noon on the first postoperative day, and the patient was discharged on the second postoperative day if he could void without assistance. Preoperative and postoperative parameters were analyzed by the Wilcoxon signed ranks test. The 31 patients had a mean age of 63.3 years, and a mean prostatic volume of 18.2ml. The preoperative parameters were compared to the postoperative parameters at 6 months following the procedure. The mean peak flow rate was 8.13 ml/s vs. 14.5 ml/s(p<0.01); the mean IPSS score was 24.0 vs. 7.31 (p<0.0l); the mean residual urine volume was 51.9 ml vs. 28.9 ml(p=0.144). The mean operative time was 53 minutes. Twenty-nine(93.5%) of the patients could void by themselves on the first postoperative day and the mean peak flow rate was increased to 12.3 ml/s. Fifteen (93.8%) of the 16 patients achieved preservation of antegrade ejaculation. There was neither water intoxication nor massive bleeding postoperatively. This modification of the Nd:YAG laser prostatectomy technique is a good alternative treatment for BPH of less than 30 ml. More than 90% of the patients could void by themselves within 24 hours after operation. The improvement of urinary flow rate was immediate and greater than 50%, and this improvement lasted for 6 months. Preservation of antegrade ejaculation in 94% of the patients is another advantage of this treatment.