BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series ...BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series of laparoscopic partial nephrectomy(LPN)by GreenLight laser enucleation without renal artery clamping.Due to the excellent coagulation and hemostatic properties of the laser,laser-assisted LPN(LLPN)makes it possible to perform a“zero ischemia”resection.METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed.All clinical information,surgical and post-operative data,complications,pathological and functional outcomes were analyzed.RESULTS Surgery was successfully completed in all patients,and no open or radical nephrectomy was performed.The renal artery was not clamped,leading to no ischemic time.No blood transfusions were required,the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred.The mean operation time was 104.3±8.2 min.The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d,and the mean postoperative hospital stay was 6.5±0.7 d.No serious complications occurred.Postoperative pathological results showed clear cell carcinoma in 12 patients,papillary renal cell carcinoma in 2 patients,and hamartoma in 1 patient.The mean creatinine level was 75.0±0.8μmol/L(range 61.0-90.4μmol/L)at 1 mo after surgery,and there were no statistically significant differences compared with pre-operation(P>0.05).The glomerular filtration rate ranged from 45.1 to 60.8 mL/min,with an average of 54.0±5.0 mL/min,and these levels were not significantly different from those before surgery(P>0.05).CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors(exogenous tumors of stage T1a)during LPN.However,use of this technique can lead to the generation of excessive smoke.展开更多
Greenlight photoselective vaporisation of the prostate (GPVP) is progressively becoming an established treatment in patients with LUTS because it is a minimally invasive technique that achieves efficient haemostasis, ...Greenlight photoselective vaporisation of the prostate (GPVP) is progressively becoming an established treatment in patients with LUTS because it is a minimally invasive technique that achieves efficient haemostasis, making it the ideal technique for patients at high surgical risk. Material and Methods: To study of 133 patients with an ASA surgical risk score of 3 or 4, undergoing GPVP, with an analysis of perioperative outcome, IPSS, Qmax, IIEF-5 and complications during a five-year follow-up. Results: At 5 years the mean annual improvement in IPSS was stable, and at 5 years there was a 15.2 point improvement versus the preoperative score (p 0.05). The Qmax showed an improvement of 14.9 ml/sec and was maintained at five years after surgery (p 0.05). No patients were transfused or suffered urinary incontinence. 2.25% suffered major complications and there were no deaths. 3.1% of patients suffered de novo urgency. In the 5-year follow-up, five patients had to be reoperated. The quality of sexual health assessed by IIEF-5 before the procedure was scored at 14 points;the 5-year follow-up covering the preoperative period and all revisions did not show any worsening in the IIEF-5 score (p > 0.05). Conclusions: Due to its physical characteristics, in our opinion GPVP is now the treatment of choice in patients at high surgical risk. In our series, the risk of major/minor complications and transfusions was much lower than the same risks in conventional techniques. The objective results (Qmax and quality of life questionnaire) are equivalent to conventional techniques and persist over a 5-year follow-up.展开更多
Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,...Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,Embase,Cochrane Library,Chinese CBM,and CNKI)were searched for eligible studies evaluating HoLEP or PVP outcomes,published until May 2022.We analyzed the incidence of relative complications and postoperative outcomes,including the international prostate symptomscore,maximum flow rate(Qmax),postvoid residual urine volume,quality of life index,and prostate-specific antigen levels.Results:Eleven studies involving 4763 patients were included in thismeta-analysis.The significant differences in postoperativeQmax at 1 month(mean difference[MD],3.31,95% confidence interval[CI],0.45-6.16,p=0.02,I^(2),92%),3 months(MD,2.78,95%CI,0.53-5.02,p=0.02,I^(2),89%),6 months(MD,2.13,95%CI,1.11-3.15,p<0.0001,I^(2),87%),and 12 months(MD,3.98,95%CI,2.06-5.89,p<0.0001,I^(2),58%)further confirmed unique advantage of HoLEP over PVP.We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups(odds ratio,0.05,95%CI,0.01 to 0.28,p=0.0005).Conclusions:Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores,quality of life index,postvoid residual urine volumes,prostate-specific antigen levels,perioperative factors,and total complication rates.Compared with PVP,HoLEP had a greater Qmax 1 year postoperatively,decreased energy expenditure,and fewer high-grade complications.These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.展开更多
目的评估经尿道绿激光前列腺剜除术(GreenLEP)治疗大体积良性前列腺增生症(BPH)的疗效与安全性。方法回顾性选取194例2019年7月至2022年8月在阜阳市第二人民医院接受160 W GreenLEP治疗的大体积(≥80 cm^(3))BPH患者的临床资料进行分析...目的评估经尿道绿激光前列腺剜除术(GreenLEP)治疗大体积良性前列腺增生症(BPH)的疗效与安全性。方法回顾性选取194例2019年7月至2022年8月在阜阳市第二人民医院接受160 W GreenLEP治疗的大体积(≥80 cm^(3))BPH患者的临床资料进行分析,主要观察指标包括患者术后至随访结束国际前列腺症状评分(IPSS)的变化、IPSS中生活质量评分(IPSS-QoL)的变化及手术并发症的发生情况。结果患者平均随访时间为22.1个月(2~36个月),术前前列腺体积平均为(95.5±27.5)cm^(3)(80.0~143.2 cm^(3)),手术时间平均(73.3±29.7)min,术中估算出血量平均(35.6±12.7)mL,随访结束IPSS评分[(6.3±5.9)分]较术前[(19.3±7.8)分]显著下降,差异具有统计学意义(P<0.001);随访结束时IPSS-QoL评分[(1.27±1.13)分]较术前[(4.20±1.40)分]显著下降,差异具有统计学意义(P<0.001)。随访结束未出现严重手术并发症。结论本研究通过3年的随访评估,表明经尿道GreenLEP治疗大体积BPH具有较好的疗效和较高的安全性。展开更多
目的:评价直出式绿激光前列腺汽化术(transurethral front-firing greenlight laser vaporization of the prostate,FFGreenLVP)在治疗高龄高危前列腺增生中的有效性和安全性。方法:回顾性分析2020年1月—2024年12月南京医科大学第二附...目的:评价直出式绿激光前列腺汽化术(transurethral front-firing greenlight laser vaporization of the prostate,FFGreenLVP)在治疗高龄高危前列腺增生中的有效性和安全性。方法:回顾性分析2020年1月—2024年12月南京医科大学第二附属医院和淮安市洪泽区人民医院收治的高龄高危前列腺增生患者(>75岁,合并有心脑血管疾病或较重的呼吸系统疾病,且均长期口服抗凝药物)的临床资料。共纳入293例,其中166例接受FFGreenLVP治疗,127例采用经尿道前列腺电切术(transurethral resection of the prostate,TURP)治疗。收集评估患者的围手术期资料,比较2组的手术时间、损失血红蛋白量、术后膀胱冲洗时间,评价手术有效性及安全性。结果:所有汽化手术均顺利完成,术中未更改手术方式,未出现严重并发症。FFGreenLVP组平均手术时间为(47.68±7.79)min、检测冲洗水血红蛋白浓度结合体积计算出平均损失血红蛋白为(4.23±1.04)g、术后需要膀胱冲洗时间平均为(4.00±0.92)d,TURP组平均手术时间为(98.20±5.98)min、检测冲洗水血红蛋白浓度结合体积计算出平均损失血红蛋白为(5.75±1.43)g、术后需要膀胱冲洗时间平均为(3.40±0.49)d,2组比较均差异有统计学意义(P<0.05),而2组前列腺体积比较差异无统计学意义。术后2个月随诊2组生活质量评分(quality of life,QoL)评分、国际前列腺症状评分(International Prostate Symptom Score,IPSS)评分比较均差异无统计学意义,FFGreenLVP组患者术后2个月最大尿流率(maximum flow rate,Qmax)较TURP组有显著改善。结论:FFGreenLVP治疗高龄高危前列腺增生患者是安全可行的,可以有效改善患者的前列腺增生症状,值得推广。展开更多
目的探讨三沟逆切法直出绿激光前列腺汽化切除术(photoselective vaporesection of the prostate,PVRP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的临床疗效及安全性。方法回顾性分析2014年6月~2016年7月PVRP治疗BPH 167...目的探讨三沟逆切法直出绿激光前列腺汽化切除术(photoselective vaporesection of the prostate,PVRP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的临床疗效及安全性。方法回顾性分析2014年6月~2016年7月PVRP治疗BPH 167例资料,采用140 W直出绿激光手术系统,于前列腺颈部5点、7点、12点位置切三条沟,深至被膜直至精阜,连接三条深沟后由精阜逆行汽化切除前列腺组织。结果手术时间(41.8±15.1)min,术中出血量(43.7±16.3)ml,术后膀胱冲洗时间(17.1±4.3)h,留置尿管时间(2.5±1.0)d。术后随访3~6个月,国际前列腺症状评分、生活质量评分、最大尿流率及残余尿量较术前均有明显改善。结论绿激光三沟逆切法PVRP治疗BPH安全,快捷,有效。展开更多
目的探讨绿激光汽化剜除术治疗大体积前列腺增生的疗效和安全性。方法选取手术治疗的124例良性前列腺增生患者(前列腺体积≥80 m L),按照手术方式分为观察组(45例)和对照组(79例),观察组采用绿激光汽化剜除术,对照组采用经尿道前列腺切...目的探讨绿激光汽化剜除术治疗大体积前列腺增生的疗效和安全性。方法选取手术治疗的124例良性前列腺增生患者(前列腺体积≥80 m L),按照手术方式分为观察组(45例)和对照组(79例),观察组采用绿激光汽化剜除术,对照组采用经尿道前列腺切除术,对比两组患者手术情况、临床疗效及并发症情况。结果两组患者手术时间比较,差异无统计学意义(P>0.05)。两组血红蛋白丢失量、膀胱冲洗时间和平均住院时间相比,差异有统计学意义(P<0.05)。观察组与对照组患者手术后的IPSS、QOL及Qmax均较手术前明显改善(P<0.05),但两组差异无统计学意义(P>0.05)。观察组术后并发症低于对照组。结论绿激光汽化剜除术治疗大体积前列腺增生安全性高,并发症少,住院时间短,疗效显著,但需要较熟练的操作技巧。展开更多
基金Supported by the Program of Shanghai Academic/Technology Research Leader,No.19XD1405100the Clinical Research Plan of SHDC,No.SHDC2020CR4025Hospital Funded Clinical Research,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.21XHDB06.
文摘BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series of laparoscopic partial nephrectomy(LPN)by GreenLight laser enucleation without renal artery clamping.Due to the excellent coagulation and hemostatic properties of the laser,laser-assisted LPN(LLPN)makes it possible to perform a“zero ischemia”resection.METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed.All clinical information,surgical and post-operative data,complications,pathological and functional outcomes were analyzed.RESULTS Surgery was successfully completed in all patients,and no open or radical nephrectomy was performed.The renal artery was not clamped,leading to no ischemic time.No blood transfusions were required,the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred.The mean operation time was 104.3±8.2 min.The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d,and the mean postoperative hospital stay was 6.5±0.7 d.No serious complications occurred.Postoperative pathological results showed clear cell carcinoma in 12 patients,papillary renal cell carcinoma in 2 patients,and hamartoma in 1 patient.The mean creatinine level was 75.0±0.8μmol/L(range 61.0-90.4μmol/L)at 1 mo after surgery,and there were no statistically significant differences compared with pre-operation(P>0.05).The glomerular filtration rate ranged from 45.1 to 60.8 mL/min,with an average of 54.0±5.0 mL/min,and these levels were not significantly different from those before surgery(P>0.05).CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors(exogenous tumors of stage T1a)during LPN.However,use of this technique can lead to the generation of excessive smoke.
文摘Greenlight photoselective vaporisation of the prostate (GPVP) is progressively becoming an established treatment in patients with LUTS because it is a minimally invasive technique that achieves efficient haemostasis, making it the ideal technique for patients at high surgical risk. Material and Methods: To study of 133 patients with an ASA surgical risk score of 3 or 4, undergoing GPVP, with an analysis of perioperative outcome, IPSS, Qmax, IIEF-5 and complications during a five-year follow-up. Results: At 5 years the mean annual improvement in IPSS was stable, and at 5 years there was a 15.2 point improvement versus the preoperative score (p 0.05). The Qmax showed an improvement of 14.9 ml/sec and was maintained at five years after surgery (p 0.05). No patients were transfused or suffered urinary incontinence. 2.25% suffered major complications and there were no deaths. 3.1% of patients suffered de novo urgency. In the 5-year follow-up, five patients had to be reoperated. The quality of sexual health assessed by IIEF-5 before the procedure was scored at 14 points;the 5-year follow-up covering the preoperative period and all revisions did not show any worsening in the IIEF-5 score (p > 0.05). Conclusions: Due to its physical characteristics, in our opinion GPVP is now the treatment of choice in patients at high surgical risk. In our series, the risk of major/minor complications and transfusions was much lower than the same risks in conventional techniques. The objective results (Qmax and quality of life questionnaire) are equivalent to conventional techniques and persist over a 5-year follow-up.
文摘Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,Embase,Cochrane Library,Chinese CBM,and CNKI)were searched for eligible studies evaluating HoLEP or PVP outcomes,published until May 2022.We analyzed the incidence of relative complications and postoperative outcomes,including the international prostate symptomscore,maximum flow rate(Qmax),postvoid residual urine volume,quality of life index,and prostate-specific antigen levels.Results:Eleven studies involving 4763 patients were included in thismeta-analysis.The significant differences in postoperativeQmax at 1 month(mean difference[MD],3.31,95% confidence interval[CI],0.45-6.16,p=0.02,I^(2),92%),3 months(MD,2.78,95%CI,0.53-5.02,p=0.02,I^(2),89%),6 months(MD,2.13,95%CI,1.11-3.15,p<0.0001,I^(2),87%),and 12 months(MD,3.98,95%CI,2.06-5.89,p<0.0001,I^(2),58%)further confirmed unique advantage of HoLEP over PVP.We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups(odds ratio,0.05,95%CI,0.01 to 0.28,p=0.0005).Conclusions:Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores,quality of life index,postvoid residual urine volumes,prostate-specific antigen levels,perioperative factors,and total complication rates.Compared with PVP,HoLEP had a greater Qmax 1 year postoperatively,decreased energy expenditure,and fewer high-grade complications.These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.
文摘目的评估经尿道绿激光前列腺剜除术(GreenLEP)治疗大体积良性前列腺增生症(BPH)的疗效与安全性。方法回顾性选取194例2019年7月至2022年8月在阜阳市第二人民医院接受160 W GreenLEP治疗的大体积(≥80 cm^(3))BPH患者的临床资料进行分析,主要观察指标包括患者术后至随访结束国际前列腺症状评分(IPSS)的变化、IPSS中生活质量评分(IPSS-QoL)的变化及手术并发症的发生情况。结果患者平均随访时间为22.1个月(2~36个月),术前前列腺体积平均为(95.5±27.5)cm^(3)(80.0~143.2 cm^(3)),手术时间平均(73.3±29.7)min,术中估算出血量平均(35.6±12.7)mL,随访结束IPSS评分[(6.3±5.9)分]较术前[(19.3±7.8)分]显著下降,差异具有统计学意义(P<0.001);随访结束时IPSS-QoL评分[(1.27±1.13)分]较术前[(4.20±1.40)分]显著下降,差异具有统计学意义(P<0.001)。随访结束未出现严重手术并发症。结论本研究通过3年的随访评估,表明经尿道GreenLEP治疗大体积BPH具有较好的疗效和较高的安全性。
文摘目的:评价直出式绿激光前列腺汽化术(transurethral front-firing greenlight laser vaporization of the prostate,FFGreenLVP)在治疗高龄高危前列腺增生中的有效性和安全性。方法:回顾性分析2020年1月—2024年12月南京医科大学第二附属医院和淮安市洪泽区人民医院收治的高龄高危前列腺增生患者(>75岁,合并有心脑血管疾病或较重的呼吸系统疾病,且均长期口服抗凝药物)的临床资料。共纳入293例,其中166例接受FFGreenLVP治疗,127例采用经尿道前列腺电切术(transurethral resection of the prostate,TURP)治疗。收集评估患者的围手术期资料,比较2组的手术时间、损失血红蛋白量、术后膀胱冲洗时间,评价手术有效性及安全性。结果:所有汽化手术均顺利完成,术中未更改手术方式,未出现严重并发症。FFGreenLVP组平均手术时间为(47.68±7.79)min、检测冲洗水血红蛋白浓度结合体积计算出平均损失血红蛋白为(4.23±1.04)g、术后需要膀胱冲洗时间平均为(4.00±0.92)d,TURP组平均手术时间为(98.20±5.98)min、检测冲洗水血红蛋白浓度结合体积计算出平均损失血红蛋白为(5.75±1.43)g、术后需要膀胱冲洗时间平均为(3.40±0.49)d,2组比较均差异有统计学意义(P<0.05),而2组前列腺体积比较差异无统计学意义。术后2个月随诊2组生活质量评分(quality of life,QoL)评分、国际前列腺症状评分(International Prostate Symptom Score,IPSS)评分比较均差异无统计学意义,FFGreenLVP组患者术后2个月最大尿流率(maximum flow rate,Qmax)较TURP组有显著改善。结论:FFGreenLVP治疗高龄高危前列腺增生患者是安全可行的,可以有效改善患者的前列腺增生症状,值得推广。
文摘目的探讨三沟逆切法直出绿激光前列腺汽化切除术(photoselective vaporesection of the prostate,PVRP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的临床疗效及安全性。方法回顾性分析2014年6月~2016年7月PVRP治疗BPH 167例资料,采用140 W直出绿激光手术系统,于前列腺颈部5点、7点、12点位置切三条沟,深至被膜直至精阜,连接三条深沟后由精阜逆行汽化切除前列腺组织。结果手术时间(41.8±15.1)min,术中出血量(43.7±16.3)ml,术后膀胱冲洗时间(17.1±4.3)h,留置尿管时间(2.5±1.0)d。术后随访3~6个月,国际前列腺症状评分、生活质量评分、最大尿流率及残余尿量较术前均有明显改善。结论绿激光三沟逆切法PVRP治疗BPH安全,快捷,有效。
文摘目的探讨绿激光汽化剜除术治疗大体积前列腺增生的疗效和安全性。方法选取手术治疗的124例良性前列腺增生患者(前列腺体积≥80 m L),按照手术方式分为观察组(45例)和对照组(79例),观察组采用绿激光汽化剜除术,对照组采用经尿道前列腺切除术,对比两组患者手术情况、临床疗效及并发症情况。结果两组患者手术时间比较,差异无统计学意义(P>0.05)。两组血红蛋白丢失量、膀胱冲洗时间和平均住院时间相比,差异有统计学意义(P<0.05)。观察组与对照组患者手术后的IPSS、QOL及Qmax均较手术前明显改善(P<0.05),但两组差异无统计学意义(P>0.05)。观察组术后并发症低于对照组。结论绿激光汽化剜除术治疗大体积前列腺增生安全性高,并发症少,住院时间短,疗效显著,但需要较熟练的操作技巧。
