高雄醫師會誌97期-醫學專欄~温聖辰-攝護腺肥大手術的屠龍刀─雷射剜除手術

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醫學專欄~温聖辰-攝護腺肥大手術的屠龍刀─雷射剜除手術

Gesundheit & Medizin

65 90
1 8.65% 106 6
13.52% 60~69
7 70
8
1827
Jean Amussat
1932 McCarthy
transitional zone
peripheral zone(
) transitional zone peripheral
zone surgical capsule
transitional zone
1990
1064nm Nd:YAG (
) ablation( )
(Nd:YAG
KTP, LBO 532nm
) vaporization( )
Nd:YAG
2011
180W Greenlight XPS system
vaporesection( )
enucleation(
transitional zone

) (Holmium)
(Thulium) (Diode)
( )
standard
procedure 70
(simple open
prostatectomy)
(0.1%)
60
80ml
TURP
>80ml
/
TURP
transitional
zone
TURP
10%(3%~14%)
7~10
/
(2%~10%) (50~70%)
(<2%)

10
80W HPS
system 120W 2011 XPS system
(180W)
TURP
44%
12ml/s
84%
(IPSS 66%) TURP
( 80W
120W )
TURP (
80W
18%
)
180W HPS system
/
(<80ml)
Peter Gilling 1998
60W
surgical capsule
bloodless plane
100~200ml
enucleation ( )

TURP randomized
control trial
(fragmentation) (dusting)
5~10
<1% 5%
10
3.1%
4.9% TURP
TURP /
2012 HoLEP
>80ml
20~50
2012
2015
2017 7
75 HoLEP
200ml
150 ( 1 g/
ml) 73ml
36 40
18~24
TURP 2017 7
200 HoLEP
( 1900nm 2013nm)
( 980nm)
capsule

vaporesection( )
capsule
enucleation
capsule
capsule
HoLEP (ThuLEP)
(DiLEP)
DiLEP
80~100ml
80ml
1. Eur Urol. 2015 Jun;67(6):1066-96. doi:
10.1016/j.eururo.2014.06.017. Epub 2014 Jun
25.
2. Urol Clin North Am. 2016 Aug;43(3):377-84.
doi: 10.1016/j.ucl.2016.04.006. Review.
3. BJU Int. 2012 Feb;109(3):408-11. doi:
10.1111/j.1464-410X.2011.10359.x. Epub
2011 Aug 23.
4. BJU Int. 2006 Nov;98(5):947-52.
5. Am J Clin Exp Urol. 2015 Apr 25;3(1):36-42.
eCollection 2015.
6. Eur Urol. 2010 Sep;58(3):384-97. doi:
10.1016/j.eururo.2010.06.005. Epub 2010 Jun
11.
7. J Endourol. 2015 Jul;29(7):797-804. doi:
10.1089/end.2015.0060. Epub 2015 Apr 2.
8. J Urol. 2015 Mar;193(3):927-34. doi: 10.1016/
j.juro.2014.09.097. Epub 2014 Sep 28.
9. Urology. 2017 Jul 19. pii: S0090-
4 2 9 5 ( 1 7 ) 3 0 7 4 8 - 3 . d o i : 1 0 . 1 0 1 6 /
j.urology.2017.07.012.
10.Urology. 1996 Jan;47(1):48-51.
11.J Urol. 2017 Jun;197(6):1517-1522. doi:
10.1016/j.juro.2016.12.098. Epub 2016 Dec
30.
12.Res Rep Urol. 2016 Oct 21;8:181-192.
eCollection 2016. Review.

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高雄醫師會誌97期-醫學專欄~温聖辰-攝護腺肥大手術的屠龍刀─雷射剜除手術

1. 65 90 1 8.65% 106 6 13.52% 60~69 7 70 8 1827 Jean Amussat 1932 McCarthy transitional zone peripheral zone( ) transitional zone peripheral zone surgical capsule transitional zone 1990 1064nm Nd:YAG ( ) ablation( ) (Nd:YAG KTP, LBO 532nm ) vaporization( ) Nd:YAG 2011 180W Greenlight XPS system vaporesection( ) enucleation( transitional zone

2. ) (Holmium) (Thulium) (Diode) ( ) standard procedure 70 (simple open prostatectomy) (0.1%) 60 80ml TURP >80ml / TURP transitional zone TURP 10%(3%~14%) 7~10 / (2%~10%) (50~70%) (<2%)

3. 10 80W HPS system 120W 2011 XPS system (180W) TURP 44% 12ml/s 84% (IPSS 66%) TURP ( 80W 120W ) TURP ( 80W 18% ) 180W HPS system / (<80ml) Peter Gilling 1998 60W surgical capsule bloodless plane 100~200ml enucleation ( )

4. TURP randomized control trial (fragmentation) (dusting) 5~10 <1% 5% 10 3.1% 4.9% TURP TURP / 2012 HoLEP >80ml 20~50 2012 2015 2017 7 75 HoLEP 200ml 150 ( 1 g/ ml) 73ml 36 40 18~24 TURP 2017 7 200 HoLEP ( 1900nm 2013nm) ( 980nm) capsule

5. vaporesection( ) capsule enucleation capsule capsule HoLEP (ThuLEP) (DiLEP) DiLEP 80~100ml 80ml 1. Eur Urol. 2015 Jun;67(6):1066-96. doi: 10.1016/j.eururo.2014.06.017. Epub 2014 Jun 25. 2. Urol Clin North Am. 2016 Aug;43(3):377-84. doi: 10.1016/j.ucl.2016.04.006. Review. 3. BJU Int. 2012 Feb;109(3):408-11. doi: 10.1111/j.1464-410X.2011.10359.x. Epub 2011 Aug 23. 4. BJU Int. 2006 Nov;98(5):947-52. 5. Am J Clin Exp Urol. 2015 Apr 25;3(1):36-42. eCollection 2015. 6. Eur Urol. 2010 Sep;58(3):384-97. doi: 10.1016/j.eururo.2010.06.005. Epub 2010 Jun 11. 7. J Endourol. 2015 Jul;29(7):797-804. doi: 10.1089/end.2015.0060. Epub 2015 Apr 2. 8. J Urol. 2015 Mar;193(3):927-34. doi: 10.1016/ j.juro.2014.09.097. Epub 2014 Sep 28. 9. Urology. 2017 Jul 19. pii: S0090- 4 2 9 5 ( 1 7 ) 3 0 7 4 8 - 3 . d o i : 1 0 . 1 0 1 6 / j.urology.2017.07.012. 10.Urology. 1996 Jan;47(1):48-51. 11.J Urol. 2017 Jun;197(6):1517-1522. doi: 10.1016/j.juro.2016.12.098. Epub 2016 Dec 30. 12.Res Rep Urol. 2016 Oct 21;8:181-192. eCollection 2016. Review.