摘要目的 探讨光选择性前列腺汽化术(PVP)治疗接受口服抗凝剂的良性前列腺增生(BPH)患者的有效性及安全性. 方法 2008年9月至2010年5月收治因心脑血管疾患长期口服华法林抗凝治疗的BPH患者7例,平均年龄74岁.不停用口服抗凝药的情况下使用100 W绿激光手术系统行PVP手术.术前凝血酶原时间(13.14 ±0.15)s.记录患者的前列腺体积、手术用时、术中出血量、术后留置导尿时间、住院天数,并评估手术前后残余尿量(PVR)、最大尿流率(Qmax)、IPSS评分. 结果 手术时间(65±22) min,术中无活动性出血及输血.手术前后血红蛋白及凝血酶原时间比较差异均无统计学意义(P＞0.05).住院天数(2.7±1.2)d.术后1个月随访,患者IPSS评分、PVR、Qmax均有显著改善(P＜0.05).术后出现尿潴留1例,4周后顺利拔除导尿.余6例患者均未出现排尿困难、血尿等不良反应. 结论 PVP术具有术前无需停服抗凝药、术中出血少等特点,对接受口服抗凝治疗的BPH患者安全、有效.由于本组例数有限,还需要大样本量的随机对照研究进一步证实PVP术在持续抗凝患者中的安全性及有效性.

abstractsObjective To evaluate the safety and efficacy of the photoselective prostate vaporization (PVP) for the patients of benign hyperplasia of prostate (BPH) with oral anti-coagulant.Methods From September 2008 to May 2010,7 cases of BPH with oral anti-coagulant were treated by PVP,with an average age of 74 years.The prothrombin time before the surgery was (13.14 ± 0.15) s.An 100 W Green-light laser source was applied in this study.The prostate volume,operating time,blood loss,catheter indwelling time after the surgery,hospital stay,PVR,Q IPSS score were recorded.Results The mean operating time was (65 ± 22) min without active bleeding or transfusion in this cohort.The haemoglobulin concentration was intact and catheter indwelling time was (22 ± 8) h,while the hospital stay was (2.7 ± 1.2) d.The PVR,Q IPSS score were significantly improved after follow-up of 1 month (P ＜0.01).One case complicated acute urinary retention after operation in this cohort,and the catheter was removed 4 weeks after α-blocker administration.Conclusions PVP is a safe and effective surgical strategy for BPH patients with oral anti-coagulant.However,since there were relatively limited cases enrolled in this study,more randomized controlled clinical trials are needed in the near future.