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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 蒙恩 | 攝護腺大小是否影響綠光雷射汽化手術的療效？ | 2012/5/30 上午 09:39:33 | 0 |
| 原 文 | 題 目 | Does Size Really Matter? The Impact of Prostate Volume on the Efficacy and Safety of GreenLight HPS™ Laser Photoive Vaporization of the Prostate |
| 作 者 | Xiao Gu, M.D., Ph.D., Gino J. Vricella, M.D., Massimiliano Spaliviero, M.D., and Carson Wong,M.D., FRCSC, FACS | |
| 出 處 | Journal of Endourology. May 2012, 26(5): 525-530. doi:10.1089/end.2011.0457. | |
| 出版日期 | Apr, 2012 | |
| 評 論 |
近年來綠光雷射汽化手術成為治療前列腺良性肥大的一大趨勢。然而對於前列腺體積較大的病人，這項手術的效果及安全性仍令人質疑。此項研究針對不同的前列腺體積良性前列腺增生（BPH）患者來探討綠光雷射汽化手術的療效和安全性。 於2006年7月和2011年2月間，從前瞻性泌尿疾病系統的數據庫抽出207例患者。根據術前經直腸超音波測量前列腺體積，將患者分為兩組進行：≥80毫升（第1組， 57人）和<80毫升（第2組，150人）。 經尿道雷射汽化手術是使用120W的GreenLight HPS側面雷射發射系統。在術前1週和4週和3，6，12，18術後24和36個月分別測定美國泌尿科協會症狀評分（AUASS），生活品質評分（QOL），最大尿流率（Qmax）及殘餘尿量（PVR）。 術前評估的結果，兩組在術前的尿滯留發生率（1：24.6％; 2：7.3％），血清前列腺特異性抗原(PSA)（1：4.5±2.7; 2：1.8±1.9 ng/mL），生活品質評分（1: 4.2±1.11; 2：4.7±0.9），平均前列腺體積（1: 118.1±37.9; 2：48.5±15.5毫升）有顯著性差異（P <0.01），而兩組之間在美國泌尿科協會症狀評分、最大尿流速和殘餘尿量均相近。在使用雷射的時間長短（1：22.8±13.3;2：10.4±6.4分鐘）和雷射能源使用量（1: 152.7±90.6; 2：70.9±44.8千焦）也有顯著性差異。 從臨床表徴（AUASS，QOL，最大尿流率，PVR）來看，不論在立即或長期的改善程度，兩組之間無顯著差異。術後的併發症發生率相當低，且兩組的發生率並無不同。 這些結果表明，前列腺體積對綠光雷射前列腺汽化手術的療效和安全性之影響不大。所以不論術前前列腺體積多大，這種技術仍然是良性前列腺增生手術一個可行的選項。 |
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| abstract |
Purpose: To evaluate the efficacy and safety of GreenLight HPS™ laser photoive vaporization of the prostate (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients with different prostate volumes. Patients and Methods: Between July 2006 and February 2011, 207 consecutive patients were identified from a prospectively maintained urologic database. Based on preoperative prostate volume measured by transrectal ultrasonography, patients were stratified into two groups: ≥80 cc (group 1, n=57) and <80 cc (group 2, n=150). Transurethral PVP was performed using a 120W GreenLight HPS side-firing laser system. American Urological Association Symptom Score (AUASS), quality-of-life (QoL) score, maximum flow rate (Qmax), and postvoid residual (PVR) volume were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24, and 36 months postoperatively. Results: Among the preoperative parameters evaluated, there were significant differences (P<0.05) in the incidence of preoperative urinary retention (1: 24.6%; 2: 7.3%), serum prostate-specific antigen level (1: 4.5±2.7; 2: 1.8±1.9 ng/mL), QoL (1: 4.2±1.1; 2: 4.7±0.9), and mean prostate volume (1: 118.1±37.9; 2: 48.5±15.5 cc), while AUASS, Qmax, and PVR were similar (P>0.05) between groups. Significant differences (P<0.05) in laser use (1: 22.8±13.3; 2: 10.4±6.4 minutes) and energy usage (1: 152.7±90.6; 2: 70.9±44.8 kJ) were also noted. Clinical outcomes (AUASS, QoL, Qmax, and PVR) showed immediate and stable improvement from baseline (P<0.05) within each group, but no significant differences between the two groups were observed during the follow-up period (P>0.05). The incidence of adverse events was low and similar in both cohorts. Conclusions: These results suggest that prostate volume has little effect on the efficacy and safety of GreenLight HPS laser PVP, and that this technique remains a viable surgical option for BPH, irrespective of preoperative prostate volume. |
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