高功率光選擇性雷射前列腺汽化術 的療效與安全性

Abstract

背景與目標：經尿道前列腺刮除術(TURP)一直是良性攝護腺肥大患者最標準、最主要的手術之一。光選擇性攝護腺組織汽化術(PVP)由於穩定度高，副作用少，近來成為風行的替代性治療方式。由於一些限制，新一代的高功率綠光雷射 (The Greenlight HPSTM) 便因應而生，但相關的文獻評估並不完整。本研究的目的，是要整理高功率綠光雷射患者的術後資料，進一步與經尿道前列腺刮除術作比較，評估其療效及安全性。 方法: 一百一十五位病患的選取來自一段期間內的一家醫院。手術種類的選擇經醫師詳細解說後，由病患自行決定。主要結果設定為國際攝護腺症狀指數、生活品質指數、最大尿流速及解後殘尿量的改善程度，各個主要結果與潛在干擾因子作多變數模型分析。另外利用包括年齡、身體質量指數、攝護腺體積及攝護腺特異抗原等因子作次族群分析。 結果：兩組的基本特徵在身高、體重、教育程度及年收入上有差異。主要結果方面，相較於TURP，國際攝護腺症狀指數(13.6 比上 11.7，P=0.046)及生活品質指數(2.91 比上 2.5，P=0.034)在PVP組改善程度較大；術中及術後的觀察發現，PVP組的失血量，鈉離子的改變量及平均住院天數都較少，平均12個月的追蹤後，發現TURP組的尿道狹窄的發生率較高(3.3% 比上14.5%，P=0.033)，多變數模型的分析在校正IPSS基礎值、年齡、身體質量指標、年收入、教育程度及攝護腺特異抗原密度後，手術種類仍是國際攝護腺症狀指數的預測因子(β=2.70, 95信賴區間為 0.71到4.69)。在次族群的分析結果，則發現在校正後，年輕和身體質量指數較高的患者，在接受PVP手術後，IPSS的改善較為明顯。四個次族群和主要結果沒有發現有交互作用的存在。 結論：經比較TURP後，我們的初步結果顯示，以高功率綠光雷射來治療良性攝護腺肥大，是一個有效及安全性高的方式，而進一步的療效及可能的副作用，則需要更長時間的追蹤來釐清。

Background and objectives: Transurethral resection of the prostate (TURP) has been the most commonly used procedure for benign prostatic hyperplasia. Photoselective vaporization of the prostate (PVP) has been evolved as an alternative. Our objectives are to evaluate the effectiveness and safety of the new high power PVP procedure. Methods: The one hundred and fifteen patients were enrolled from a single hospital at the same period, and they choose the preferred procedure after the advantages and disadvantages were informed. The major outcomes include improvements of international prostatic symptom score (IPSS), IPSS quality of life scores, maximum flowrate and postvoided residuals, and multivariate models analysis with potential confounders adjustments were used to evaluate the strength of the relationships between the major outcomes and the 2 different procedures. The subgroup for age, body mass index, prostate volume and prostatic specific antigen were analyzed for interaction. Results: The basic demographics were listed, and the parameters including height, weight, education level and annual income were significantly different between the 2 groups. Compared to TURP, the PVP group had better outcomes in IPSS improvements(13.6 versus 11.7, P=0.046), quality of life score change (2.91 versus 2.5, P=0.034). After 12 months of follow up duration, the TURP group showed higher urethral stricture rates (3.3% versus 14.5%, P=0.033). The multivariate analysis resulted in, after adjusted, PVP was a prediction factor for IPSS improvements versus TURP(estimate coefficient=2.70, 95 confidence interval=0.71 – 4.69).. The subgroup analyses showed younger and high BMI patients receive greater IPSS effects after PVP therapy Conclusions: Our results showed that PVP offers effectiveness for BPH and advantageous over TURP with regard to operative safety. The long term follow up is needed to evaluate the durability and possible morbidity.