绿光PVP的治疗良性前列腺增生(31).ppt

林口長庚紀念醫院高齡泌尿外科崔克宏醫師,revolixnewlaserforsurgery,introduction,bphisamajorcauseoflutsinmenhalfofallmenovertheageof50willdevelopthiscondition,alsoknownasbenignprostatichyperplasiabythetimeamanreacheshis70sor80s,80%willexperienceurinarysymptoms,benignprostatichyperplasia(bph)isacommondiseaseprocessthataffectsanage,epidemiologyofbphhistologicprevalencearoundtheworld,blaivasjg.urolclinnortham1985;12:21524,whatsluts?,voiding(obstructive)symptomshesitancyweakstreamstrainingtopassurineprolongedmicturitionfeelingofincompletebladderemptyingurinaryretention,storage(irritativeorfilling)symptomsurgencyfrequencynocturiaurgeincontinence,lutsisnotspecifictobphnoteveryonewithlutshasbphandnoteveryonewithbphhasluts,surgicaltreatment,transurethralresectionofprostate(tur-p),goldstandardprocedurelaserprostatectomy:greenlightpvprevolix:thuliumlaser雙極利尿雷射urolas980,thetur-p,indication:contraindications:procedures:?complications:,tur-p,laserprostatectomy,1.pvp2.thulium3.diode,absorptionvs.avelength,980nmis2300timesmoreabsorbedinh2othan532nm532nmis74timesmoreabsorbedinhbo2than980nm,200w,120w,70w,thuliumlaservaporizationforbenignprostatichypertrophy:outcome,林口長庚紀念醫院高齡泌尿外科崔克宏醫師,revolix:lasertypeandspecification,lasertype:diodepumpedsolidstatelaserdpss(thulium銩laser)(the2micronlaserisexcitedbyaninternaldiodelaser.)wavelength:2micrometerpower:5watt70watt,adjustableoperationalmode:continuouswave(cw)chopped:50millisecondstocontinuousdeliverysystem:flexiblesilicafibres,opticalpenetrationdepth,diode980nm,revolix銩雷射,revolix:fieldsofapplication,endourology:tur-laser,openingofstrictures,incisions,excisions,ablationofbladdertumours.openurology:excisionoftumoursfromthecortexofthekidney,bladdersurgery.,prostatetissueaftervaporesectionwithrevolix,x20x40x100,nodeeppenetration!only0.2mmnecrosis,removemediamlobeofprostate,removelaterallobeofprostate,revolixinurology:ureterstricture,術前,術後,toevaluatedtheclinicaloutcomeofbph,materialsandmethods,betweenoct2007andmay2009theageof54-94(average76.4)80patientswithbphtreatedwiththuliumlasertherapy,patients,acuteurinaryretention:38(47.5%)pre-oppsa:3.6-28.53(mean8.78)preoppv:43.5-120ml(mean85ml)t-zone:mean58ml,categoriesofinformationevaluationforassessingtheresultsofimplementingthuliumlaser,categoryadmissionday1(op)day2(dischage),labtestcbc,u/a,buncr,ekgsugar,na,k,cl,albuminradiologycxr,kubpharmacologyivfcantibioticsimanalgesicsanalgesics(oral)cantibiotics(oral)cop&anesthesiaoppermitpvpnursingprepareanesthesiapreparespecifictesttrusurodynamicsothersvitalsignscfleetenemadietnpo3wayfoley,irrigationremovingfoley,results,optime:median1.45hourshospitalstay(mean):2days75(93%)needovernightirrigationfor12hoursmeandurationofcatheterization:16hours,resultsofthuliumlaserin80patients,initial3months6months12months,aua-si27.7+5.78.7+4.56.8+5.06.2+4.7peakflow(ml/s)2.3+3.716.5+5.116.4+5.214.8+6.1qol4.4+1.11.04+0.651.04+0.651.64+0.92,morbidityprofile,itermnoincidence%,incontinence00uti56.2hematuria11.25urineretention22.5reopforcheckbleeding11.25impotence00bladderneckstenosis/stricture11.25prostatecancer67.5,conclusions,thuliumlaseroffersrapidtiss