【摘要】 目的 总结80 W绿激光汽化术治疗大体积良性前列腺增生症的技术及临床疗效。 方法 回顾性分析2007年9月-2009年11月完成经尿道80 W绿激光汽化术治疗体积gt;100 mL良性前列腺增生症患者围手术期及随访资料，包括术前前列腺体积、血红蛋白、国际前列腺症状评分（IPSS）、生活质量（QOL）评分，手术时间、汽化激光能量及术后血清钠、血红蛋白、术后留置尿管时间、IPSS、QOL评分、3个月后残余前列腺体积等。 结果 45例体积gt;100 mL的良性前列腺增生症患者均在持续硬膜外麻醉下完成手术，无中转开放手术。术前前列腺体积（128.82±24.82） mL，血红蛋白（138.5±6.85） g/mL，IPSS评分27.10±2.88，QOL 4.26±0.87，术前最大尿流率（6.53±3.76） mL/s，手术时间（141.00±30.19） min，汽化能量（36.14±11.64） MJ，术后3 d血红蛋白（124.33±7.64） g/mL，术后留置尿管时间（101.55±20.55） h，术前与术后血清钠无明显变化，血红蛋白轻度下降，无需输血。3个月后残余前列腺体积（44.63±10.31） mL，IPSS评分11.58±2.52，QOL 2.74±1.10。无尿道狭窄发生。 结论 经尿道80 W 绿激光汽化术治疗体积gt;100 mL的良性前列腺增生症，具有良好的安全性和临床疗效，可作为此类患者的首选治疗之一。【Abstract】 Objective To investigate the efficacy and safety of 80 Watt high-power potassium-titanyl-phosphate (KTP) photoselective laser vaporization of the prostate (PVP) in patients with large-volume benign prostate hyperplasia (gt;100 mL). Methods Retrospective analysis was performed in patients with large-volume benign prostatic hyperplasia (gt;100 mL), who were treated with the 80 Watt KTP transurethral photoselective laser vaporization of the prostate from September 2007 to November 2009. The preoperative evaluation included prostate volume by transrectal ultrasonic scanning, serum sodium and serum hemoglobin, international prostate symptom score (IPSS) and quality of life (QOL) score. The operative time and vaporization energy and average indwelling catheterization time were recorded. The postoperative serum sodium, serum hemoglobin after the operation were compared with those before the operation. After 3 months, the IPSS, QOL and residual prostate volume were evaluated. Results Forty-five patients of totally 219 patients with gt;100 mL prostate in volume were successfully operated under continuous epidural anesthesia. None was changed to open operation. The mean preoperative prostate volume was (128.82±24.82) mL, the mean IPSS was (27.10±2.88) and QOL were (4.26±0.87). The mean operative time was (141.00±30.19) minutes. The mean indwelling catheterization was (102.17±19.50) hours. The serum sodium did not change, while the serum hemoglobin level reduced mildly but without transfusion. After 3 month, the mean IPSS was (11.58±2.52) and QOL were (2.74±1.10) with residual prostate volume was (44.63±10.31) mL. No stricture was observed in 〖LM〗this group. Conclusion The transurethral photoselective vaporization of the prostate with 80 Watt KTP laser is a safe and effective therapy for patients with gt;100 mL prostate in volume in experienced PVP center.
Objective To evaluate the effective method for treatment of premacular hemorrhage. Methods In 36 cases (36 eyes) of premacular hemorrhage (2PD),25 cases were treated with medicine, and 11 cases were treated with laser surgery and medicine. Results In 25 patients treated with medicine, the average time of vision recovery was 24 days and the average time of clearance of vitreous hemorrhage was 40 days; in the other 11 patients treated with laser surgery and medicine,10 were treated successfully, and in these 10 patients, the average time of vision recovery were 5 days and the average time of clearance of premacular hemorrhage were 11 days in 10 cases which were operated successfully with laser in 11 cases. Conclusions Laser surgery of inducing preretinal hemorrhage to vitreous body is an effective method for treatment of premacular hemorrhage to relieve the impaired central vision. (Chin J Ocul Fundus Dis, 2002, 18: 199-201)
Objective To investigate the early influences of laser photocoagulation on retinal function in diabetic retinopathy(DR)． Methods The multifocal electroretinograms (MERG) of 30 eyes with DR (phase Ⅲ～Ⅳ) were tested with visual evoked response image system IV b efore,and the 3rd day and the 7th day after laser photocoagulation． Results Three days after photocoagulation, the latency of N1 prolonged in the central macula 5deg; area and superionasal quadrant．Th e response densities of N1,P1 and N2 markedly reduced, and most significant changes occurred in the central macula 5deg; area and then in the central 10deg;area． There were also differences in the changes of the amplitude of N1 and P1 in diff erent quadrants ．The changes of visual acuity were positively related to the de crease of amplitudes of N1,P1 and N2 in the macula． Conclusion The reduction of response densities in MERG reveals functional damage in diabetic retina occurring early after photocoagulation．The functional damage in macula induced indirectly by photocoagulation may explain the reduction of visual acuity after panretinal photocoagulation in some degree． (Chin J Ocul Fundus Dis, 2001,17:181-183)
ObjectiveTo evaluate the prognosis of photocoagulation and (or) cryotherapy for prethreshold type 1 and threshold disease of retinopathy of prematurity (ROP).MethodsThe data of 29 eyes of 15 infants who were diagnosed as with prethreshold type 1 or threshold disease of ROP from Jan 30th, 2003 to Jan 13th, 2005 were retrospectively analysed. Pre- and post-operative conditions of ROP were compared in the follow up. Any related local and systemic complications were recorded.ResultsIn 29 eyes which had undergone photocoagulation and (or) cryotherapy, ROP regressed completely in 19 (65.5%), remained dragged retina was found in 7 (24.1%), and retinal detachment was seen in 3 (103%). ROP regressed completely in 12 eyes (41.4%) after the initial treatment and in 7 eyes (24.1%) after the secondary treatment. During the treatment, temporary corneal haze was found in 2 eyes, vitreous hemorrhage occurred in 1 eye, and inadvertent photocoagulation at macular area happened in 1 eye. No systemic complications were found in all cases.ConclusionTimely treatment of photocoagulation and (or) cryotherapy for prethreshold type 1 and threshold disease of ROP may lead to famous prognosis.(Chin J Ocul Fundus Dis,2005,21:278-281)
Purpose To evaluate the safety and efficacy of draining subretinal fluid with transchoroidal probing by using the traditional needling and diode endolaser probing. Methods The investigation included 70 consecutive patients(74 eyes) with rhegmatogenous retinal detachment undergoing scleral buckling surgery.Seventy cases were randomly divided into 2 groups,group A 34 cases(36 eyes)with the needle drainage procedure and group B 36 cases(38 eyes) with the diode probe respectively.The safety and efficacy were compared in between the 2 groups. Results No operative failure was found in these 2 groups.In group A,subretinal hemorrhage occurred in 3 eyes,and retinal incarceration,retinal preforation in one eye. No significant complication occurred in group B. Conclusion Diode laser drainage has the advantage in that it may reduce the incidence of operative complication with drainage.This technique might be used in any case requiring drainage of subretinal fluid especially of rhegmat ogenous retinal detachment in cases of shallow retinal detachment. (Chin J Ocul Fundus Dis,1998,14:202-203)
Objective To evaluate the clinical effect of percutaneous laser disc decompression (PLDD) in the treatment of cervical disc herniation. Methods From March 2003 to December 2005, 47 patients with cervical disc herniation(96 cervical disc) were treated with PLDD. There were 25 males and 22 females with an average age of 56 years, ranging from 37 to72 years. The lesion were located at the levels of C3,4 in 20 discs, C4,5 in 27 discs, C5,6 in 31 discs, C6,7 in 18 discs. The laser fiber was introduced into the center of the herniated disc space by percutaneous puncture from anterior neck surface under fluoroscopic guidance. Laser reduced the intradisc pressure through the vaporization of disc nucleu. The adopted laser was semiconducted with a wavelength of 810 nm. Each laser output power was15 W with 1 s emission and 2 s interval. The total laser output power was decided depending on the degenerative degree of the disc and the reactive process of heat, ranging from 300 to 1 000 J.Results Of 47 patients,42 were followed up for 3 to 31 months (mean 13 months). The clinical evaluation was classified as excellent in 18 cases (42.9%), good in 14 cases (33.3%), fair in 6 cases (14.3%) and poor in 4 cases (9.5%). The general response rate was 90.5%. The excellent and good rate was 76.2%. No complications occurred. Conclusion PLDD can relieve the symptoms and signs of patients suffering from cervical disc herniation with less complication. The manipulation of PLDD is easy, safe and mini-invasive.