高功率钬激光在膀胱颈挛缩病人行颈部楔形切开术中的应用

doi:10.3969/j.issn.1005-6483.2020.02.007

摘要/Abstract

摘要：

目的评估高功率钬激光在膀胱颈挛缩病人行颈部楔形切开术中应用的效果及可行性。

方法膀胱颈挛缩病人60例，随机分为对照组和实验组，每组各30例，对照组行经尿道膀胱颈电切术，实验组采用科医人80～100W，550μm钬激光手术系统实施膀胱颈部楔形切开术，观察两组的临床效果。

结果对照组病人手术时间、导尿保留时间、术中失血量和住院时间，分别为（100.95±18.74）分钟，（7.86±1.95）天，（86.98±10.69）ml和（8.95±1.95）天；实验组分别为（26.78±4.28）分钟，（2.96±0.54）天，（10.45±1.82）ml 和（3.64±0.79）天，两组比较差异有统计学意义（P＜0.05）。治疗前，两组病人QOL评分、IPSS评分、PVR和Qmax差异无统计学意义（P>0.05）；治疗7天后，实验组QOL评分、IPSS评分、PVR和Qmax分别为（2.74±0.52）分，（10.68±1.94）分，（65.49±12.36）ml和（14.89±2.46）ml/s；对照组分别为（4.86±0.86）分，（15.95±2.89）分，（100.69±21.34）ml和（10.37±2.14）ml/s，均显著优于治疗前（P＜0.05），实验组改善程度较大。治疗6个月后实验组QOL评分、IPSS评分、PVR和Qmax分别为（1.74±0.25）分，（6.84±1.49）分，（20.69±3.52）ml和（21.48±4.68）ml/s，对照组分别为（2.96±0.48）分，（12.74±2.35）分，（43.74±6.84）ml和（15.43±3.92）ml/s。两组比较差异有统计学意义（P＜0.05）。实验组和对照组并发症发生率分别为3.33%和13.33%，两组比较差异有统计学意义（P＜0.05）。

结论高功率钬激光在膀胱颈挛缩病人行颈部楔形切开术中安全有效，出血少、操作时间短、操作简便。

关键词: 高功率钬激光, 膀胱颈挛缩, 颈部, 楔形切开术, 微创

Abstract:

Objective To evaluate the clinical effect and feasibility of high power holmium laser wedge neck resection in patients with bladder neck contracture.

Methods 60 patients were randomly divided into two groups：30 patients in each group；the control group received transurethral resection of bladder neck；the experimental group received wedge resection of bladder neck with medical staff 80～100w and 550um holmium laser surgery system，and the clinical effect was observed.

Results Inthe control group，the operative time，catheter retention time，intraoperative blood loss and hospitalization time were（100.95±18.74）min，（7.86±1.95）d，（86.9±10.69）ml，（8.95±1.95）d，The experimental groups were（26.78±4.28）min，（2.96±0.54）d，（10.45±1.82）ml，（3.64±0.79）d，the comparison between the two was statistically significant（P<0.05）.Before treatment，there was no statistically significant difference in quality of life （QOL），international prostate symptom score （IPSS），postvoid residual volume （PVR）and maxium urinary flow rate （Qmax）between the two groups（P>0.05）.7d After treatment，QOL score，IPSS score，PVR and Qmax in the experimental group and control group were（2.74±0.52）score，（10.68±1.94）score，（65.49±12.36）ml，（14.89±2.46）ml/s；（4.86±0.86）score，（15.95±2.89）score，（100.69±21.34）ml，（10.37±2.14）ml/s，all of which were significantly better than those before treatment（P<0.05），and the improvement degree of the patients in the experimental group was greater.Six months after treatment，the QOL，IPSS，PVR and Qmax were（1.74±0.25）score，（6.84±1.49）score，（20.69±3.52）ml and（21.48±4.68）ml/s，in the experimental group，the control group were（2.96±0.48）score，（12.74±2.35）score，（43.74±6.84）ml and（15.43±3.92）ml/s，the experimental group was better than the control group（P<0.05）.The complication rate of the experimental group（3.33%）was lower than that of the control group（13.33%）（P<0.05）.

Conclusion High power holmium laser is safe and effective for neck wedge resection in patients with bladder neck contracture，with less bleeding，short operation time and simple operation，which is an ideal minimally invasive surgical method.

Key words: high power holmium laser, bladder neck contracture, neck, wedge incision, minimally invasive surgery

徐安, 李东, 张瑜, 杨刚刚, 赵树田. 高功率钬激光在膀胱颈挛缩病人行颈部楔形切开术中的应用[J]. 临床外科杂志, 2020, 28(2): 121-124.

XU An, LI Dong, ZHANG Yu, et al.. Application of high power holmium laser in wedge neck resection of patients with bladder neck contracture[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(2): 121-124.

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