选择性绿激光锂三硼酸晶体激光 Vaporesection 前列腺的研究
Summary
在这里, 我们提出了一个协议, 以执行前列腺选择性绿激光 Vaporesection (PVRP) 良性前列腺增生 (BPH) 治疗。
Abstract
良性前列腺增生 (BPH) 所致下尿路症状 (LUTS) 的发生是老年男性人群中发病率较高的常见问题。虽然它不是一种危及生命的疾病, 但 BPH 会引起严重影响生活质量的问题。在这里, 我们介绍了一种新的技术, 称为前列腺选择性绿激光 vaporesection (PVRP) 治疗前列腺增生症, 这可以看作是选择性绿激光汽化前列腺 (PVP) 的变化。与 PVP 技术相比, 激光能量损失少, 术中并发症少, 组织切除率更低, 具有较好的应用效果。
Introduction
虽然经尿道前列腺切除术仍被接受为金标准的良性前列腺增生 (BPH) 外科治疗, 激光手术已逐渐变得更加流行, 由于更好的病人耐受性, 少术中失血, 疗效满意, 术后恢复较短1,2,3。目前, 世界上最常用的用于 BPH 治疗的激光器是由锂钾草酸磷酸酯或锂三硼酸 (杠杆) 晶体 4, 5 生成的.传统上, 这些被归类为 sidefiring 激光器, 与其他类型的激光相比, 如钬激光和铥激光器。
选择性绿激光汽化的前列腺 (PVP) 手术可能大大降低经尿道炎综合征, 由于盐水灌溉6, 7, 并与其他类型的激光器相比, 下尿路综合征 (LUTS) 的可靠疗效PVP 通过一系列研究得到验证8,9,10。然而, 与侧向发射激光发射相关的 PVP 也有一些缺点, 包括能量损失近20% 和短寿命的激光光纤11,12,13。此外, PVP 还增加了由于完全组织汽化而导致前列腺癌漏诊的可能性。
采用端选择性绿激光 Vaporesection 的前列腺 (PVRP) 的引入成功地克服了上述 PVP 的大部分缺点。首先, 尖端是能够发射激光到组织几乎没有能量损失术。其次, 当纤维碎片在刀尖上采集时, 简单地去除受影响的零件, 就可以直接保持理想的输出功率。最后, 激光切除可使标本的采集用于术后病理检查。因此, 采用本协议治疗前列腺增生症可提高组织切除率, 节省手术时间, 提高术中的安全性。
Protocol
这里描述的所有方法都已被北京医院伦理委员会批准。手术的适应症是根据欧洲泌尿外科指南 nonneurogenic 男性 LUTS 协会。禁忌症包括疑似前列腺癌或逼尿肌功能障碍。 1. 操作工具 确保有一个最大功率为 160 W 的杠杆收购晶体激光器的可用性。 采用 endfiring 激光纤维和盐水溶液进行膀胱冲洗。 使用26F 激光电切镜获得良好的视力和提高切除效率。 <p…
Representative Results
在我们的一项研究中, 共有35名接受 PVRP 的病人被纳入其中。平均患者年龄为 72.1, 7.1 岁 (范围53-85 年)。 围手术期数据列在表 1中。平均激光发射时间占平均手术时间的近50%。大多数患者的失血是 < 200 毫升。然而, 由于一些中等程度的出血病例, 平均偏差。近90% 的患者在术后6天内取出导管。 <p class="jove_content" fo:k…
Discussion
在这里, 我们分享我们的经验与 PVRP。首先, PVRP 能够更好地暴露前列腺胶囊的正确标定和降低胶囊穿孔的风险。第二, 应沿手术胶囊进行组织切除, 特别是在12点的凹槽上进行, 这有利于前列腺尿道周围的组织切除, 并提供满意的组织切除率。第三, 在前列腺尿道中先切除中叶, 以获得更宽的通道, 提高手术的可视化效果是至关重要的。如果有大的中间裂片与膀胱颈部介入, 我们强烈建议, 标记应绘制在…
Declarações
The authors have nothing to disclose.
Acknowledgements
作者没有确认。
Materials
| FLARE surgical Laser Fiber | REALTON | The FLARE Surgical laser Fiber is a 600 micron fiber with an straight tip that transmits the laser energy directly. this product is packaged sterile for disposable use and should not be re-sterilized or reused. Dispose of properly after use. | |
| AURORA Surgical Green Laser System | REALTON | pvp-160-021 | The AURORA Surgical green laser system is a diode-pumped, frequency-doubled Nd:YAG solid state laser. The AURORA Surgical green laser system features a “Plug and Play” capability that self-adjusts to the facility’s individual voltage requirements, eliminating the need for electrical modifications. The laser system also includes an air-cooled internal mechanism, ensuring safe operating temperatures with no external water connections. Laser energy emission and system status selection is activated through a surgeon-controlled, color-coded footswitch or system touch screen feature located in the laser console. |
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Tags
Photoselective VaporesectionBenign Prostatic HyperplasiaLithium Triborate Crystal LaserMinimally Invasive ProcedureLow Laser Energy LossFewer Intraoperative ComplicationsTransurethral Resection Of The ProstateVisual DemonstrationsPreoperative AntibioticDorsal Lithotomy PositionBladder DistensionLaser VaporizationMiddle Lobe RemovalLateral Lobe Vaporesection
Citar este artigo
Wang , X., Zhang, Y., Zhu, S., Wan, B., Liu, M., Wang, J. Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser. J. Vis. Exp. (135), e57336, doi:10.3791/57336 (2018).