전립선비대증 환자에서 부분 혹은 국소마취하에서 레이저를 이용한 전립선절제술의 임상경험 77례
Clinical Experience of Laser Prostatectomy under Regional or Local Anesthesia in 77 Patients with Benign Prostatic Hyperplasia
박명승, 박종관, 임채상,
소속 상세정보
박명승 ( )
전북대학교 의과대학 비뇨기과학교실
박종관 ( )
전북대학교 의과대학 비뇨기과학교실
임채상 ( )
전북대학교 의과대학 비뇨기과학교실
KMID : 0358319980390020162
Abstract
결론
본 교실에서 초기 경험한 lased prostatectomy 77례를 대상으로 임상적 결과를 비교 분석
시 1, 3, 6개월과 1년 추적검사에서 AUA symptom score는 감소하였으며, 최대요속은 요역
동학 검사상 호전된 좋은 결과를 보였다.
수술 후 이환률, 합병증과 수술 후 증상 등의 현저한 감소결과를 보였고, 특히 수술에 대한
스트레스가 적어 환자나 보호자들에게 전립선비대증의 일차적 수술요법으로 선호도가 매우
높았다.
VAS를 이용한 수술 중 통증정도 평가의 평균치는 30.6mm로 임상적으로 의의 있는 수치
를 보여 ,동반된 내과적 질환으로 전신마취나 척수마취가 어려웠던 환자에서도 국소마취 하
에서 laser prostatectomy가 안전하게 시행될 수 있었다.
전립선비대증의 최근 치료 경향이 보다 간편하고 비침해적이면서도 만족할만한 치료방법을
원하고 있고, laser prostatectomy가 이에 부응하는 좋은 치료결과를 보여, 임상적 응용에서
경요도적 전립선절제술을 대치할만한 비침해적이고 효과적인 치료방법으로 사료되며, 앞으
로 더 많은 환자에서 장기간의 추적관찰이 이루어진 후에 laser prostatectomy의 정확한 평
가가 이루어질 수 있으리라고 생각한다.
#초록#
Purpose: This prospective study was designed to evaluate the efficacy and safety of
Nd: YAG laser for the treatment of benign prostatic hyperplasia(BPH).
Materials and Methods: From January 1994 to March 1995, 77 patients with BPH were
underwent laser prostatectomy. Of the 77 patients 17 were performed under local
anesthesia. Preoperative and postoperative(at 1, 3 and 6months after operation) evaluation
consisted of uroflowmetry, American Urological Association(AUA) symptom score and
posboid residual urine. There were no limits of the prostatic size for operation and 2
cases had 100gm of prostatic weight. Multiple dragging technique(from the bladder neck
to the verumontanum) with 90°fiber at 80 to 90watts power were used in near contact
or contact.
Results: 69 patients of total 77 patients have completed 6months follow-up evaluation.
Mean prostatic size was 39.7gm. Preoperative mean urine flow rate was 3.0ml/sec and
postoperative urine flow rate at one, three and six months was 10.7, 13.8 and
13.6m1/sec, respectively.
Preoperative AUA score was 26.6 and postoperative AUA score at one, three and six
month was 9.6, 7.6, respectively. Preoperative residual urine was 251.4ml and
postoperative residual urine at one, three and six months was 57.0, 15.3 and 19.4ml,
respectively. In 17 cases laser prostatectomy was done under local anesthesia due to
poor medical condition. The results of laser prostatectomy under local anesthesia was
not different from the cases with regional anesthesia. And the degree of subjective Pain
of the Patients in local anesthesia was tolerable.
The total energy used was about 129,000 Joules and the mean operative time was 103
minutes. Foley catheter was removed on postoperative 5th day. A total of 7 patients
failed in initial voiding trials and required catheterization longer than 2weeks
postoperatively. In 3 cases of seven patients who complained discomfort on voiding after
3months, necrotic tissue was present on cystoscopy. There were no severe
complications.
Conclusion: It is concluded that the technique of transurethral laser-induced
prostatectomy is effective and less invasive technique alterative than traditional
transurethral resection of the prostate.
키워드
Benign prostatic hyperplasia; Laser prostatectomy;
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