전립선비대증 환자에 대한 간질성 레이저응고술의 초기경험
Early Clinical Experience of Interstitial Coagulation(ILC) for the Treatment of Benign Prostatic Hyperplasia
김경식, 오문목,
소속 상세정보
김경식 ( )
성애병원 비뇨기과
오문목 ( )
성애병원 비뇨기과
KMID : 0358319990400020201
Abstract
결론
1996년 4월부터 1997년 1월까지 전립선비대증으로 본원에 내원한 환자중 16명을 대상으로
Indigo Medical 회사의 Indigo 830eTM Laser Optic Treatment System를 이
용한 간질성 레이저응고술을 시행하여 수술 전과 수술 후 1개월 및 2개월 째의 국제전립선
증상점수, 삶의 질, 최대요속, 평균요속, 잔뇨량 등을 비교하여 치료효과를 분석하고 합병증
을 검토하며 본 결과, 간질성 레이저응고술은 치료효과가 매우 우수하면서도 시술이 비교적
간단하고 비침습적인 방법으로 출혈 및 전해질이상이 거의 없어 전신상태가 불량한 고령의
환자와 전립선 크기가 커서 경요도전립선절제술을 시행하기 어려운 환자에서도 안전하게 시
행할 수 있는 효과적인 치료법이라 생각된다.
Purpose : Variable modalities, with more comfortable and less incidence of
post-operative complications over TURP, have been used for the treatment of benign
prostatic hyperplasia(BPH) with bladder outlet obstruction. Recently, we performed
Interstitial Laser Coagulation(ILC) with the 830nm diode laser, which is considered as a
method of minimally invasive treatments for BPH, to assess the efficacy and safety of
the device, and to evaluate its capability of replacing TURP for managing BPH.
Materials and Methods : We analysed 16 patients, who had suffered from symptomatic
BPH, treated with ILC using diode laser retrospectively from April 1996 to January 1997.
Mean age of the patients was 71.7(52-84) years old and mean size of prostates before
the treatments was 52.2(26.8-100.7)gm. Treatment outcome was estimated by comparing
IPSS, QOL, Qmax, Qave and residual urine before the operations with them of first and
second month after the operations. Post-operative transrectal ultrasonography was able
to several cooperative cases and they were compared with them of pre-operative
volumes, too, although it was unavailable to evaluate statistically.
Results : The operation were performed under epidural or spinal anesthesia with
average time of 62 minutes and with 10 days of post-operative catheterization. IPSS
reduced from 22.25(±4.82), mean value before the operation, to 11.00(±5.58) and 5.00(±
3.10) at first and second month after ILC. QOL was gradually decreased from 4.44(±
0.51) to 2.31(±1.20) and 1.19(±0.91), too. In terms of Qmax, mean was 12.29(±5.55)㎖
/sec before the operation and it was increased to 15.94(±7.38)㎖/sec and 20.75(±8.48)㎖
/sec. Average flow rate was also increased from 6.98(±2.05)㎖/sec to 10.38(±3.72)㎖/sec
and 14.93(±4.37)㎖/sec. Significant reduction was observed in residual urine volume
from 98.13(±91.72)㎖ to 33.19(±36.58)㎖ and 9.56(±11.24)㎖ respectively. Minimal
hematuria and mild bladder irritations were common symptoms after the procedure, and
possible significant complications as like anemia, electrolyte imbalance(post-TUR
syndrome), epididymoorchitis, erectile dysfunction, urethral stricture, retrograde
ejaculation had not found in our experience, but 1 patient was retreated with TURP
because of continued bladder outlet obstruction.
Conclusions : Our initial results with ILC showed that it is a relatively simple and
minimally invasive method with minimal occurrence of bleeding and no electrolyte
imbalance. We concluded that ILC is a safe and efficacious treatment modality, and it
can be used even for elder patients with co-morbidity illness as well as patients with
too large prostate to perform TURP.
키워드
Benign prostatic hyperplasia; Diode laser; Interstitial laser coagulation of prostate;
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